NEET-PG 2013 - Obstetrics and Gynecology Practice Questions

Q: What is the most common presenting symptom of TB endometritis?

Infertility. ***Infertility*** - **Infertility** is the most common presenting symptom of **tuberculosis (TB) endometritis**, particularly secondary infertility. - The infection leads to inflammation and scarring of the endometrium and fallopian tubes, impairing implantation and ovum transport. *Abdominal pain* - While **abdominal pain** can occur in TB endometritis, it is typically a less frequent or prominent presenting symptom compared to infertility. - Pain often arises from pelvic inflammation or adhesions but is not the cardinal complaint that prompts diagnosis. *Amenorrhoea* - **Amenorrhea** (absence of menstruation) can be a symptom, especially in advanced cases where there is significant destruction of the endometrium. - It is, however, less common than infertility as the initial presenting symptom. *Vaginal discharge* - **Vaginal discharge** is an uncommon symptom of TB endometritis. - When present, it is often non-specific and not characteristic enough to suggest TB as the underlying cause.

Q: What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?

Within 3 weeks. **Correct Answer: Within 3 weeks** - The highest risk of **Pelvic Inflammatory Disease (PID)** after IUD insertion is typically observed in the **first 20 days (approximately 3 weeks)** post-insertion. - This elevated risk is mainly due to the potential introduction of **bacteria** from the vagina or cervix into the uterus during the insertion process. - Studies show that the risk of PID is **6-fold higher** in the first 20 days compared to later periods. *Incorrect: Within 5 weeks* - While PID can occur after 3 weeks, the **highest incidence** is concentrated in the earlier period (first 3 weeks). - The risk significantly **decreases after the initial weeks**, suggesting that the critical window for bacterial ascent is shorter. *Incorrect: Within 7 weeks* - By 7 weeks, the risk of developing PID attributable to IUD insertion becomes **negligible** compared to the general population. - Most infections that manifest beyond the initial month are usually due to **newly acquired sexually transmitted infections (STIs)**, not the insertion itself. *Incorrect: Within 14 weeks* - At 14 weeks, any PID development is generally **not linked to the IUD insertion event** but rather to other risk factors like new sexual partners or untreated STIs. - The immediate trauma and potential bacterial contamination from the insertion procedure have **long ceased to be the primary cause** of infection.

Q: Acute PID, the most common route of spread?

Ascending infection. ***Ascending infection*** - **Pelvic Inflammatory Disease (PID)** most commonly occurs when microorganisms from the **lower genital tract (vagina, cervix)** ascend into the upper genital tract (uterus, fallopian tubes, ovaries). - This upward spread leads to infection and inflammation of the endometrium (endometritis), fallopian tubes (salpingitis), and ovaries (oophoritis). *Descending* - A descending route of infection implies spread from an organ superior to the pelvis, which is not the typical mechanism for acute PID. - While infections can sometimes spread from adjacent structures, direct downward spread from non-genital organs is rare for primary PID. *Lymphatics* - While lymphatic spread can occur in some infections, it is not the primary or most common route for the initial onset of acute PID. - Lymphatic spread is more commonly associated with chronic or severe infections, or specific types of pelvic infections like tuberculosis. *Hematogenous* - Hematogenous spread involves pathogens traveling through the bloodstream to reach the pelvic organs. - This route is less common for typical acute PID but can be seen in cases of systemic infections or specific sexually transmitted infections like tuberculosis.

Q: What is the primary maternal cause of fetal macrosomia (large birth weight) in newborns?

Hyperglycemia. ***Hyperglycemia*** - Maternal **hyperglycemia**, often due to **gestational diabetes**, leads to increased glucose transfer across the placenta to the fetus. - This excess glucose stimulates increased fetal insulin production, which acts as a growth hormone causing macrosomia. *Hyperinsulinemia* - While fetal **hyperinsulinemia** directly causes macrosomia by increasing fetal growth, it is a **consequence** of maternal hyperglycemia, not the primary cause itself. - Fetal insulin acts as an anabolic hormone, promoting fat and protein synthesis and overall growth. *Multiparity* - **Multiparity** (having given birth to multiple children) is generally associated with moderately higher birth weights, but it is not the primary cause of macrosomia. - The effect is far less significant and consistent than that of maternal hyperglycemia. *Post maturity* - **Post-term pregnancy** (post maturity) can sometimes be associated with a larger birth weight, but this is less common and less pronounced than macrosomia caused by hyperglycemia. - Fetal growth often slows or even declines in prolonged pregnancies due to placental insufficiency.

Q: A patient presents with a history of vaginal prolapse and a painful ulcer on the prolapsed tissue. What is the most likely diagnosis?

Decubitus ulcer. ***Decubitus ulcer*** - A **decubitus ulcer** (pressure sore) is the most likely diagnosis when a patient with a **vaginal prolapse** develops a **painful ulcer** on the prolapsed tissue due to chronic pressure and friction. - The prolapsed tissue is often exposed to constant irritation and lack of proper blood supply, making it susceptible to ulceration. *Carcinoma* - While possible, carcinoma typically presents as a **non-healing lesion** with irregular borders and induration, and is often *not immediately painful* in its early stages. - A definitive diagnosis of carcinoma requires **biopsy and histopathological examination**. *Pressure erosion* - This term is a general description of tissue damage from pressure and can be a precursor to a decubitus ulcer, but **decubitus ulcer** specifically denotes the developed lesion. - It describes the *mechanism of injury* rather than the specific, fully formed ulcer. *Syphilis* - Syphilis causes a **chancre**, which is typically a *painless ulcer* with indurated borders. - It is a sexually transmitted infection, and while it could cause an ulcer, the context of a **vaginal prolapse** points more strongly to a localized pressure injury.

Q: Which condition is associated with HAIR-AN syndrome?

Polycystic Ovary Syndrome (PCOS). ***Polycystic Ovary Syndrome (PCOS)*** - **HAIR-AN syndrome** is a specific, severe form of **PCOS**, characterized by **HyperAndrogenism**, **Insulin Resistance**, and severe **Acanthosis Nigricans**. - It represents the most pronounced metabolic and endocrine abnormalities associated with PCOS, often with significant hyperinsulinemia. *Endometriosis* - Endometriosis involves the growth of **endometrial-like tissue outside the uterus**, causing pain and infertility. - It is not directly linked to the metabolic and hormonal disturbances seen in HAIR-AN syndrome. *CA ovary* - **Ovarian cancer** is a malignant proliferation of ovarian cells, which is not associated with the unique features of **hyperandrogenism**, **insulin resistance**, or **acanthosis nigricans** that define HAIR-AN syndrome. - Ovarian tumors can be hormone-producing, but this is distinct from the syndrome's chronic metabolic dysregulation. *Adrenal tumours* - **Adrenal tumors** can cause **hyperandrogenism** in some cases, leading to symptoms like hirsutism, but they typically do not present with the constellation of **insulin resistance** and severe **acanthosis nigricans** that define HAIR-AN syndrome. - The primary defect in HAIR-AN is ovarian and metabolic, rather than adrenal.

Q: Which hormone is known to be elevated in Polycystic Ovary Syndrome (PCOS)?

Luteinizing Hormone (LH). ***Luteinizing Hormone (LH)*** - In **Polycystic Ovary Syndrome (PCOS)**, there is often an elevated **Luteinizing Hormone (LH)** level, leading to an increased **LH:FSH ratio**. - This high LH level contributes to **increased androgen production** by the ovaries, a key feature of PCOS. *FSH* - **Follicle-stimulating hormone (FSH)** levels are typically normal or even low in PCOS, contributing to the **imbalance with LH**. - This relative deficiency of FSH impairs proper **follicle maturation**, leading to anovulation and cyst formation. *Estrogen* - While **estrogen** levels can be normal or slightly elevated due to peripheral conversion of androgens, they are not primarily responsible for the characteristic hormonal imbalance in PCOS. - The elevated **androgens** in PCOS are converted to estrogen in adipose tissue, but this is a secondary effect. *TSH* - **Thyroid-stimulating hormone (TSH)** is involved in thyroid function and is generally unrelated to the **pathophysiology of PCOS**, although thyroid disorders can co-exist with PCOS. - Elevated TSH suggests **hypothyroidism**, a distinct endocrine condition that would present with different symptoms.

Q: In Stein-Leventhal syndrome, which hormone is raised?

LH. ***LH*** - In **Stein-Leventhal syndrome** (Polycystic Ovary Syndrome, PCOS), there is an elevated **LH (Luteinizing Hormone)** level. - This high LH-to-FSH ratio contributes to increased **androgen production** by the ovarian theca cells, leading to symptoms like hirsutism and anovulation. *FSH* - **FSH (Follicle-Stimulating Hormone)** levels are typically normal or even low in PCOS, contributing to the elevated LH:FSH ratio. - Low FSH levels impair proper follicle maturation, leading to **anovulation** and the characteristic polycystic appearance of the ovaries. *GnRH* - **GnRH (Gonadotropin-Releasing Hormone)** secretion can be altered in PCOS, often showing increased pulse frequency, which preferentially stimulates LH release over FSH. - However, **GnRH levels themselves are not directly measured** as "raised" in the clinical diagnostic criteria for PCOS. *Progesterone* - **Progesterone** levels are often low or absent in PCOS, particularly in the luteal phase, due to **anovulation**. - The lack of regular ovulation means no corpus luteum forms, which is responsible for progesterone production after ovulation.

Question 1

What is the most common fetal complication associated with gestational diabetes?

Accepted Answer

There is a risk of macrosomia in babies born to mothers with gestational diabetes.

Answer

Only a small percentage of women with gestational diabetes develop overt diabetes.

Answer

Gestational diabetes is usually diagnosed in the second or third trimester.

Answer

Gestational diabetes can increase the risk of congenital malformations.

Question 2

What is the most common presenting symptom of TB endometritis?

Accepted Answer

Infertility

Answer

Amenorrhoea

Answer

Vaginal discharge

Answer

Abdominal pain

Question 3

What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?

Accepted Answer

Within 3 weeks

Answer

Within 5 weeks

Answer

Within 7 weeks

Answer

Within 14 weeks

Question 4

Acute PID, the most common route of spread?

Accepted Answer

Ascending infection

Answer

Descending

Answer

Lymphatics

Answer

Hematogenous

Question 5

What is the primary maternal cause of fetal macrosomia (large birth weight) in newborns?

Accepted Answer

Hyperglycemia

Answer

Hyperinsulinemia

Answer

Multiparity

Answer

Post maturity

Question 6

A patient presents with a history of vaginal prolapse and a painful ulcer on the prolapsed tissue. What is the most likely diagnosis?

Accepted Answer

Decubitus ulcer

Answer

Carcinoma

Answer

Pressure erosion

Answer

Syphilis

Question 7

Which condition is associated with HAIR-AN syndrome?

Accepted Answer

Polycystic Ovary Syndrome (PCOS)

Answer

CA ovary

Answer

Adrenal tumours

Answer

Endometriosis

Question 8

Which hormone is known to be elevated in Polycystic Ovary Syndrome (PCOS)?

Accepted Answer

Luteinizing Hormone (LH)

Answer

FSH

Answer

Estrogen

Answer

TSH

Question 9

In Stein-Leventhal syndrome, which hormone is raised?

Accepted Answer

LH

Answer

FSH

Answer

GnRH

Answer

Progesterone

Question 10

Which of the following actions should be avoided during the delivery of an Rh-negative mother?

Accepted Answer

Gently perform manual removal of placenta if necessary

Answer

Withhold ergometrine until after anterior shoulder delivery

Answer

Administer IV fluids

Answer

Apply fundal pressure during second stage of labor

NEET-PG 2013 — Obstetrics and Gynecology