Obstetrics and Gynecology
10 questionsIn which part of the fallopian tube is there a high chance of rupture in a tubal pregnancy?
Most common site of ectopic pregnancy is -
What percentage of ectopic pregnancies occur in the fallopian tube?
Which drug is commonly used in the medical management of ectopic pregnancy?
Most common congenital uterine anomaly is?
What is the recommended timing for the insertion of a Copper T intrauterine device?
Intrauterine adhesions best seen by?
Which hormone is primarily responsible for insulin resistance during pregnancy?
Which of the following statements about gestational diabetes mellitus (GDM) is true?
What is the most common presenting symptom of TB endometritis?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1221: In which part of the fallopian tube is there a high chance of rupture in a tubal pregnancy?
- A. Interstitial
- B. Fimbrial
- C. Isthmus (Correct Answer)
- D. Ampulla
Explanation: ***Isthmus*** - The **isthmus** is the narrowest and most muscular part of the fallopian tube. Due to its limited ability to stretch, an ectopic pregnancy here is highly prone to rupture **earlier** than in other segments (typically 6-8 weeks). - The **isthmic portion's** small lumen and thick muscular wall make rupture a rapid and common complication, often before significant fetal growth, giving it the **highest chance of rupture** when an ectopic pregnancy implants there. *Ampulla* - The **ampulla** is the most common site for ectopic pregnancies (approximately 70%) due to its wider lumen and being the usual site of fertilization. - However, rupture in the ampulla tends to occur **later** than in the isthmus (8-12 weeks) as it can accommodate the growing embryo for a longer period due to its greater distensibility. - While more ectopic pregnancies occur here in absolute numbers, each individual ampullary pregnancy has a **lower chance of rupture** compared to isthmic pregnancies. *Interstitial* - The **interstitial** (or cornual) part is the segment within the uterine wall, making it a rare site for ectopic pregnancies (2-4%). - Ruptures in the interstitial portion occur **latest** (12-16 weeks) but are often the most dangerous, leading to severe hemorrhage due to the surrounding vascularity of the uterus and proximity to uterine and ovarian arteries. *Fimbrial* - The **fimbrial** end is the portion closest to the ovary and is exceedingly rare for ectopic implantation. - Implantation near the fimbriae usually leads to an **"abdominal pregnancy"** if the embryo is extruded, or could result in early "tubal abortion" rather than a true rupture.
Question 1222: Most common site of ectopic pregnancy is -
- A. Cervical
- B. Tubal (Correct Answer)
- C. Abdominal
- D. Ovarian
Explanation: ***Tubal*** - The **fallopian tubes** are the most common site for ectopic pregnancies, accounting for over **95%** of all cases. - This is because the fertilized ovum typically implants in the tube rather than reaching the uterus. *Abdominal* - **Abdominal ectopic pregnancies** are rare, occurring when the fertilized egg implants in the abdominal cavity. - They account for about **1%** of all ectopic pregnancies and often result in significant maternal complications. *Ovarian* - **Ovarian ectopic pregnancies** are very rare, occurring when the ovum is fertilized within the ovary itself. - They represent less than **1%** of all ectopic cases and can be difficult to diagnose. *Cervical* - **Cervical ectopic pregnancies** involve implantation within the cervical canal. - These are also very rare (less than **1%** of ectopic pregnancies) and are associated with a high risk of severe hemorrhage.
Question 1223: What percentage of ectopic pregnancies occur in the fallopian tube?
- A. 90% (Correct Answer)
- B. 75%
- C. 80%
- D. 67%
Explanation: ***90%*** - Approximately **90-95%** of all ectopic pregnancies occur within the fallopian tube, making it the most common site. - The **ampulla** is the most frequent tubal site, accounting for about 80% of tubal ectopics, followed by the isthmus and fimbrial end. *75%* - While a significant percentage, **75%** falls short of the actual prevalence of tubal ectopic pregnancies. - This percentage does not accurately reflect the high frequency of implantation within the fallopian tube. *80%* - **80%** is a common statistic for ectopic pregnancies occurring in the **ampulla** specifically, which is a segment of the fallopian tube. - However, the overall percentage for all fallopian tube locations is higher than 80%. *67%* - **67%** is too low and does not represent the vast majority of ectopic pregnancies that are found within the fallopian tube. - Such a low percentage would imply a higher incidence of ectopic pregnancies in other locations (e.g., ovary, cervix, abdomen), which is not the case.
Question 1224: Which drug is commonly used in the medical management of ectopic pregnancy?
- A. Leuprolide
- B. Methotrexate (Correct Answer)
- C. Mifepristone
- D. Carboprost
Explanation: ***Correct: Methotrexate*** - **Methotrexate** is a **folic acid antagonist** that inhibits DNA synthesis and cell proliferation, making it effective in terminating early ectopic pregnancies by targeting rapidly dividing trophoblastic cells. - It is typically considered for **hemodynamically stable** patients with unruptured ectopic pregnancies, a beta-hCG level below a certain threshold (e.g., <5,000 mIU/mL), and no cardiac activity in the ectopic mass. - This is the **gold standard** for medical management of ectopic pregnancy meeting specific criteria. *Incorrect: Mifepristone* - **Mifepristone** is an **antiprogestin** primarily used for medical abortion of intrauterine pregnancies, causing detachment of the gestational sac and cervical ripening. - While it can be used in combination with misoprostol for medical abortion, it is **not the primary drug** for managing ectopic pregnancies. *Incorrect: Leuprolide* - **Leuprolide** is a **GnRH agonist** mainly used for conditions like endometriosis, uterine fibroids, and prostate cancer by suppressing ovarian or testicular hormone production. - It is **not used** in the direct medical management of ectopic pregnancy. *Incorrect: Carboprost* - **Carboprost** is a **prostaglandin F2-alpha analog** primarily used to treat **postpartum hemorrhage** by inducing strong uterine contractions. - It is **not indicated** for the treatment of ectopic pregnancy.
Question 1225: Most common congenital uterine anomaly is?
- A. Bicornuate uterus
- B. Unicornuate uterus
- C. Arcuate uterus
- D. Septate uterus (Correct Answer)
Explanation: ***Septate uterus*** - A septate uterus is the most common congenital uterine anomaly, characterized by a **fibrous or muscular septum** dividing the uterine cavity. - This anomaly results from incomplete resorption of the **müllerian ducts** during development. *Bicornuate uterus* - A bicornuate uterus involves **two uterine horns** that are partially or completely separate, leading to a heart-shaped uterus. - While relatively common, it is **less prevalent** than the septate uterus. *Unicornuate uterus* - A unicornuate uterus is an anomaly where only **one side of the müllerian duct develops**, resulting in a uterus with only one horn and one fallopian tube. - This is a **rare anomaly** compared to septate and bicornuate uteri. *Arcuate uterus* - An arcuate uterus is considered a **mild variant of a normal uterus**, with a slight indentation in the fundus. - It often has **no clinical significance** and is less severe than other anomalies.
Question 1226: What is the recommended timing for the insertion of a Copper T intrauterine device?
- A. 3 days after periods are over
- B. Within 10 days of start of menstrual cycle (Correct Answer)
- C. Just after menstruation
- D. During active pelvic infection
Explanation: ***Within 10 days of start of menstrual cycle*** - Inserting the **Copper T IUD** during this phase ensures the woman is not pregnant, as ovulation typically occurs later in the cycle. - The **cervix is slightly dilated** during menstruation, making insertion easier and less uncomfortable. - This is the **recommended timing** as per standard guidelines for IUD insertion. *3 days after periods are over* - While this timing might seem appropriate, it doesn't align with the optimal window for ensuring **non-pregnancy** and ease of insertion. - The **cervix may have already closed** significantly, making insertion potentially more difficult than during menstruation. *During active pelvic infection* - Insertion of an IUD during an **active pelvic infection** is **absolutely contraindicated** due to the risk of exacerbating the infection and leading to more serious complications like **pelvic inflammatory disease (PID)**. - The presence of infection increases the likelihood of bacteria being carried into the **uterine cavity**, potentially causing severe consequences. *Just after menstruation* - While close to the ideal window, this timing is less specific than "within 10 days" and may miss the optimal cervical conditions. - The benefits of a slightly dilated cervix during the early menstrual phase would be maximized with the more precise timing of within 10 days of cycle start.
Question 1227: Intrauterine adhesions best seen by?
- A. Hysteroscopy (Correct Answer)
- B. Ultrasound
- C. Computed Tomography
- D. Magnetic Resonance Imaging
Explanation: ***Hysteroscopy*** - **Hysteroscopy** provides direct visualization of the uterine cavity, allowing for precise identification and characterization of **intrauterine adhesions (IUA)** or **Asherman's syndrome**. - It not only diagnoses IUAs but also allows for simultaneous treatment through **adhesiolysis**, making it the gold standard for both diagnosis and management. *Ultrasound* - While ultrasound can sometimes suggest the presence of adhesions through abnormal endometrial appearances or fluid collections, it is generally **not definitive** for diagnosing IUAs. - Its sensitivity is limited, especially for subtle or fine adhesions, and it often requires confirmation by other methods. *Computed Tomography* - **Computed Tomography (CT)** scans are generally **not used** for the diagnosis of intrauterine adhesions. - CT provides limited soft tissue contrast in the endometrial cavity and exposes the patient to **ionizing radiation**, without offering a clear advantage over other imaging modalities. *Magnetic Resonance Imaging* - **Magnetic Resonance Imaging (MRI)** can provide good soft tissue detail and may visualize severe adhesions, but it is **not as sensitive or specific** as hysteroscopy for detecting all types of IUAs. - MRI is more expensive and less accessible than hysteroscopy, and it does not allow for immediate therapeutic intervention.
Question 1228: Which hormone is primarily responsible for insulin resistance during pregnancy?
- A. Estrogen
- B. HPL (Correct Answer)
- C. Progesterone
- D. GH
Explanation: ***HPL*** - **Human placental lactogen (HPL)**, also known as **chorionic somatomammotropin**, directly induces maternal insulin resistance to ensure a continuous supply of glucose to the fetus. - HPL levels rise throughout pregnancy, peaking in the third trimester, correlating with increasing insulin resistance. *Estrogen* - While **estrogen** levels are high in pregnancy, its primary role is in supporting uterine growth and maintaining the pregnancy, not directly causing significant insulin resistance. - High estrogen levels can enhance insulin sensitivity in some contexts, contrasting with the overall insulin resistance of pregnancy. *Progesterone* - **Progesterone** is crucial for maintaining pregnancy and relaxing smooth muscle but does not directly cause the marked insulin resistance seen in gestation. - It works synergistically with other hormones but is not the primary driver of glucose intolerance in pregnancy. *GH* - **Growth hormone (GH)** does contribute to insulin resistance in non-pregnant individuals and at high levels can cause insulin resistance, but it is not the primary hormone responsible for the unique physiological insulin resistance of pregnancy. - While GH is present, **HPL** is the dominant somatotropic hormone of pregnancy directly impacting glucose metabolism.
Question 1229: Which of the following statements about gestational diabetes mellitus (GDM) is true?
- A. It is always associated with a previous history of IUGR.
- B. There is no recurrence of GDM in future pregnancies.
- C. There is no risk of developing overt diabetes in the future.
- D. Gestational diabetes mellitus is first recognized during pregnancy. (Correct Answer)
Explanation: ***Gestational diabetes mellitus is first recognized during pregnancy.*** - GDM is defined as **glucose intolerance** that is first recognized or diagnosed during pregnancy, regardless of whether it requires insulin or persists after pregnancy. - This definition distinguishes it from **pre-existing type 1 or type 2 diabetes** diagnosed before conception. *It is always associated with a previous history of IUGR.* - GDM is primarily associated with an increased risk of **macrosomia** (large-for-gestational-age babies) due to high maternal glucose levels stimulating fetal insulin production and growth. - While other pregnancy complications can occur, **intrauterine growth restriction (IUGR)** is not a typical or consistent association with GDM. *There is no recurrence of GDM in future pregnancies.* - Women who have had GDM in one pregnancy have a **significantly increased risk** (30-50%) of developing it again in subsequent pregnancies. - This recurrence risk highlights the underlying predisposition to glucose intolerance. *There is no risk of developing overt diabetes in the future.* - A history of GDM is a strong predictor for developing **type 2 diabetes** later in life, with up to 50% of women developing it within 5-10 years post-delivery. - It also carries a small increased risk of developing **type 1 diabetes** in some individuals.
Question 1230: What is the most common presenting symptom of TB endometritis?
- A. Amenorrhoea
- B. Vaginal discharge
- C. Abdominal pain
- D. Infertility (Correct Answer)
Explanation: ***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.