What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?
Which of the following symptoms is least commonly associated with endometriosis?
USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?
In which stage of cervical carcinoma is surgery performed to retain the possibility of conception?
Bishop scoring is done for ?
Which of the following is the most common genital infection in pregnancy?
Which drug is associated with decreased fetal heart rate during labor?
What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?
A young sexually active female presents with intense pruritus and watery discharge. What is the most likely causative organism?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 41: What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?
- A. Cyclical OC pill
- B. Continuous OC pill (Correct Answer)
- C. Progesterone only pill
- D. Danazole
Explanation: ***Continuous OC pill*** - For **mild endometriosis** in a young woman, **continuous oral contraceptive pills (OCP)** are the **first-line medical treatment** according to current evidence-based guidelines (ACOG, ESHRE). - Continuous OCP use provides better suppression of endometriosis by creating a **stable hormonal environment** that prevents cyclic menstrual bleeding and retrograde menstruation, which can worsen endometriosis. - This approach effectively manages symptoms like **dysmenorrhea** and **pelvic pain** while preserving future fertility, and is well-tolerated in young women with the added benefit of menstrual suppression. *Cyclical OC pill* - While cyclical OCPs can help manage endometriosis symptoms, they are **less effective** than continuous OCPs because they allow withdrawal bleeding, which may perpetuate retrograde menstruation and endometrial implant stimulation. - Cyclical OCPs may still provide symptom relief but are considered a **second-line option** when continuous use is not acceptable to the patient. *Progesterone only pill* - **Progesterone-only pills (POP)** can suppress endometriosis by inducing amenorrhea and decidualization of endometrial implants, but they may cause **irregular bleeding patterns**, especially in the first few months. - While effective, they are generally considered when combined OCPs are contraindicated (e.g., migraine with aura, thrombotic risk) rather than as first-line for uncomplicated mild endometriosis. *Danazole* - **Danazol** is an androgenic agent that creates a hypoestrogenic environment, leading to atrophy of endometrial tissue, but it is **rarely used today** due to significant androgenic side effects. - Common side effects include **acne**, **hirsutism**, **weight gain**, and **voice deepening**, which are often unacceptable for a 21-year-old woman, making it an obsolete option for first-line management of mild endometriosis.
Question 42: Which of the following symptoms is least commonly associated with endometriosis?
- A. Vaginal discharge (Correct Answer)
- B. Infertility
- C. Chronic pelvic pain
- D. Dyspareunia
Explanation: ***Vaginal discharge*** - **Vaginal discharge** is a symptom more commonly associated with **infections or cervical issues**, rather than endometriosis. - While women with endometriosis may experience occasional discharge, it is **not a primary or characteristic symptom** of the condition itself. *Infertility* - **Infertility** is a very common issue for women with endometriosis, affecting their ability to conceive due to **inflammation, scarring, and anatomical distortion** of reproductive organs. - Endometrial implants can **disrupt ovarian function**, block fallopian tubes, and create a hostile uterine environment. *Chronic pelvic pain* - **Chronic pelvic pain** is the hallmark symptom of endometriosis, often severe and debilitating. - It results from the **inflammation, adhesions, and nerve sensitization** caused by ectopic endometrial tissue growing outside the uterus. *Dyspareunia* - **Dyspareunia**, or **painful intercourse**, is frequently experienced by women with endometriosis. - This symptom typically occurs when endometrial implants are located on the **uterosacral ligaments, posterior cul-de-sac, or rectovaginal septum**, leading to irritation during deep penetration.
Question 43: USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
- A. Renal pathway obstruction (Correct Answer)
- B. Neuromuscular disorder
- C. Gastrointestinal obstruction
- D. Anencephaly
Explanation: ***Renal pathway obstruction*** - **Oligohydramnios** (low amniotic fluid) in the late second or third trimester is often caused by conditions that impair fetal urine production or outflow. - **Renal pathway obstruction** (e.g., posterior urethral valves, bilateral renal agenesis) prevents the fetus from producing or excreting sufficient urine, a primary source of amniotic fluid. *Gastrointestinal obstruction* - **Gastrointestinal obstruction** is more commonly associated with **polyhydramnios** because it impairs the fetal swallowing of amniotic fluid. - Inability to swallow leads to an *accumulation* of amniotic fluid, not a reduction. *Anencephaly* - **Anencephaly** is typically associated with **polyhydramnios** due to impaired swallowing of amniotic fluid. - The exposed brain tissue can also lead to increased fluid transudation. *Neuromuscular disorder* - **Neuromuscular disorders** can cause **polyhydramnios** if they lead to impaired fetal swallowing due to muscle weakness. - If a neuromuscular disorder affects the renal system, it could potentially cause oligohydramnios, but it is not the primary cause of oligohydramnios itself.
Question 44: What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?
- A. Insufficient progesterone due to anovulation (Correct Answer)
- B. Excess estrogen production from ovarian follicles
- C. Hypothalamic dysfunction affecting ovulation
- D. High levels of progesterone due to luteal phase defect
Explanation: ***Insufficient progesterone due to anovulation*** - Anovulation prevents the formation of a **corpus luteum**, which is responsible for producing progesterone. - The lack of progesterone leads to an **unstable, proliferative endometrium** that eventually sheds irregularly, causing abnormal uterine bleeding. - This is the **primary hormonal defect** in anovulatory DUB. *Excess estrogen production from ovarian follicles* - While **unopposed estrogen** is present in anovulatory cycles, the primary issue is the *absence of progesterone*, not necessarily excess estrogen production. - Estrogen levels may be normal or even low, but without progesterone to stabilize the endometrium, irregular shedding occurs. - Excess estrogen primarily leads to **endometrial hyperplasia** rather than irregular bleeding. *Hypothalamic dysfunction affecting ovulation* - Hypothalamic dysfunction (e.g., due to stress, extreme exercise) can be an *underlying cause* of anovulation. - However, the *primary hormonal mechanism* of the bleeding itself is the subsequent lack of progesterone, not the hypothalamic dysfunction directly. *High levels of progesterone due to luteal phase defect* - A **luteal phase defect** involves *insufficient* progesterone production or response, not high levels. - High progesterone levels would stabilize the endometrium and promote regular shedding, preventing DUB.
Question 45: In which stage of cervical carcinoma is surgery performed to retain the possibility of conception?
- A. Stage 1B1 (Correct Answer)
- B. Stage 1B2
- C. Stage 2A
- D. Stage 2B
Explanation: ***Stage 1B1*** - In **Stage 1B1 cervical carcinoma** (FIGO 2018), the tumor size is **≤2 cm** and confined to the cervix, making it amenable to **fertility-sparing surgery** like radical trachelectomy. - This stage allows for removal of the cervix and parametrium while preserving the **uterine body** and ovaries, thus retaining the possibility of conception. - Strict selection criteria must be met including tumor size ≤2 cm, no lymphovascular space invasion, negative lymph nodes, and adequate follow-up compliance. *Stage 1B2* - **Stage 1B2** (FIGO 2018) involves tumors **>2 cm to ≤4 cm** but still confined to the cervix, which generally have a higher risk of recurrence and lymph node metastasis. - While fertility-sparing surgery might be considered in highly selective cases with tumors 2-3 cm, it is much less commonly performed than in Stage 1B1 due to the increased tumor burden and higher oncological risk. *Stage 2A* - In **Stage 2A cervical carcinoma**, the tumor has spread beyond the cervix to involve the upper two-thirds of the vagina (2A1: ≤4 cm, 2A2: >4 cm) but not the parametrium. - The disease extent typically necessitates more aggressive treatment such as radical hysterectomy or **chemoradiation**, precluding preservation of fertility in most cases. *Stage 2B* - **Stage 2B** involves tumor invasion into the **parametrium**, making fertility-sparing surgery contraindicated and typically requiring **definitive chemoradiation**. - The spread of cancer to the parametrium indicates a more advanced disease that cannot be adequately treated by methods that preserve fertility.
Question 46: Bishop scoring is done for ?
- A. Exchange transfusion in newborns
- B. Newborn ventilation assessment
- C. Newborn gestation assessment
- D. Induction of labor assessment (Correct Answer)
Explanation: ***Induction of labor assessment*** - The **Bishop score** is a pre-labor scoring system used to assess the ripeness of the cervix. - A higher score indicates a more **favorable cervix** for the successful **induction of labor**. *Exchange transfusion in newborns* - **Exchange transfusion** is primarily indicated for severe hyperbilirubinemia or hemolytic disease in newborns. - Its assessment is based on **bilirubin levels** and other clinical factors, not the Bishop score. *Newborn ventilation assessment* - **Newborn ventilation assessment** involves evaluating respiratory effort, heart rate, and oxygenation status, often using scores like the **Apgar score**. - The Bishop score is unrelated to neonatal respiratory function. *Newborn gestation assessment* - **Newborn gestation assessment** is typically performed using methods like the **New Ballard Score** or by reviewing prenatal ultrasound dating. - The Bishop score is used in *maternal* obstetric management, not directly for neonatal gestational age estimation.
Question 47: Which of the following is the most common genital infection in pregnancy?
- A. Vaginal candidiasis (Correct Answer)
- B. Gonorrhea
- C. Chlamydia
- D. Bacterial vaginosis
Explanation: ***Vaginal candidiasis*** - **Vaginal candidiasis**, commonly known as a yeast infection, is the **most frequent genital infection** during pregnancy due to hormonal changes that alter the vaginal microenvironment. - Pregnancy increases susceptibility through **elevated estrogen levels**, **increased vaginal glycogen**, and **altered vaginal pH**. - While generally not harmful to the fetus, it can cause significant maternal discomfort with symptoms like **itching**, burning, and a **thick, white, cottage cheese-like discharge**. *Gonorrhea* - Gonorrhea is a **sexually transmitted infection (STI)** that, although possible, is not the most common genital infection in pregnancy. - It carries a risk of serious complications for both mother and infant, including **preterm birth**, **chorioamnionitis**, and **neonatal conjunctivitis** (ophthalmia neonatorum). *Chlamydia* - Chlamydia is another **STI** that can occur during pregnancy but is not as common as candidiasis. - Untreated chlamydia can lead to **preterm rupture of membranes**, **preterm labor**, and **postpartum endometritis** in the mother, and **conjunctivitis** or **pneumonia** in the newborn. *Bacterial vaginosis* - Bacterial vaginosis (BV) is a common vaginal infection caused by an **imbalance in normal vaginal flora**, with overgrowth of anaerobic bacteria. - While BV is the most common vaginal infection in **non-pregnant women**, vaginal candidiasis is more frequently encountered during pregnancy due to hormonal changes. - BV in pregnancy is associated with increased risk of **preterm birth**, **preterm rupture of membranes**, and **postpartum endometritis**, making screening and treatment important.
Question 48: Which drug is associated with decreased fetal heart rate during labor?
- A. Oxytocin (Correct Answer)
- B. Sodium bicarbonate
- C. IV fluids
- D. Iron
Explanation: ***Oxytocin*** - **Oxytocin** stimulates uterine contractions, which can reduce blood flow to the placenta and temporarily decrease **fetal oxygenation**, leading to **fetal heart rate decelerations**. - Overstimulation of the uterus by oxytocin can result in **tachysystole** (>5 contractions in 10 minutes), potentially causing **fetal hypoxia** and associated changes in fetal heart rate patterns such as late decelerations or bradycardia. *Sodium bicarbonate* - **Sodium bicarbonate** is used to correct metabolic acidosis, but it does not directly affect **fetal heart rate** or uterine activity in a way that causes decelerations. - Its administration is unlikely to impact fetal heart rate unless the underlying condition causing acidosis also affects fetal well-being, which is not a direct drug effect. *IV fluids* - **Intravenous fluids** are often administered during labor to maintain hydration and support maternal circulation, which generally helps improve **fetal well-being** and maintain normal fetal heart rate patterns. - They can help optimize **uterine perfusion**, thereby improving oxygen delivery to the fetus and reducing the risk of fetal distress. *Iron* - **Iron** is essential for red blood cell production and preventing maternal anemia; it has no direct or acute effect on **fetal heart rate** during labor. - Administered as a supplement, iron is not a medication used during labor to impact **uterine contractility** or fetal heart rate in the way oxytocin does.
Question 49: What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?
- A. 10mg
- B. 20mg
- C. 200mg (Correct Answer)
- D. 100mg
Explanation: ***200mg*** - The standard dose of **mifepristone** for medical termination of pregnancy (MTP) is **200mg orally**. - This dose is typically followed 24-48 hours later by a **prostaglandin analog** (e.g., misoprostol) to complete the termination process. *10mg* - This dose is significantly lower than the recommended therapeutic dose for medical abortion. - Such a low dose would likely be **ineffective** in achieving termination. *20 mg* - This dose is also much lower than the standard therapeutic recommendation. - It would not adequately block progesterone receptors to initiate the termination process effectively. *100mg* - While closer to the standard dose, 100mg is still considered **sub-therapeutic** for many individuals undergoing medical abortion. - A lower efficacy rate would be expected compared to the 200mg dose.
Question 50: A young sexually active female presents with intense pruritus and watery discharge. What is the most likely causative organism?
- A. Chlamydia trachomatis
- B. Candida albicans
- C. Gardnerella vaginalis
- D. Trichomonas vaginalis (Correct Answer)
Explanation: ***Trichomonas vaginalis*** - **Trichomoniasis** commonly presents with **intense vulvovaginal pruritus**, a **frothy, greenish-yellow discharge**, and sometimes a **strawberry cervix**. - It is a **sexually transmitted infection (STI)** caused by a flagellated protozoan. *Candida vaginitis* - Typically causes severe **pruritus**, **dysuria**, and a **thick, white, curd-like discharge**, often without the watery characteristic. - Known as a **yeast infection**, it is caused by an overgrowth of *Candida* species. *Gardnerella vaginalis* - Associated with **bacterial vaginosis**, which presents with a **thin, grayish-white discharge** and a **fishy odor**, especially after intercourse, but usually less intense pruritus. - It's characterized by an imbalance of vaginal flora rather than being a true STI in the same sense as trichomoniasis. *Chlamydia trachomatis* - Often causes **asymptomatic infections** or symptoms such as **mucopurulent discharge**, **dysuria**, or **post-coital bleeding**, but usually **not intense pruritus** or watery discharge. - It is a **bacterial STI** known for causing cervicitis and pelvic inflammatory disease.