Which of the following is an indication for use of Hormone Replacement Therapy in menopausal women:-
Which among the following is not a premalignant lesion of vulva?
In uterine prolapse, how do you assess if a pessary ring is properly in place?
NEET-PG 2018 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 21: Which of the following is an indication for use of Hormone Replacement Therapy in menopausal women:-
- A. Post menopausal bleeding
- B. Hot flushes (Correct Answer)
- C. Cardiovascular protection
- D. Pyelonephritis
Explanation: ***Hot flushes*** - Hormone Replacement Therapy (HRT) is highly effective in alleviating **vasomotor symptoms** like hot flushes and night sweats, which can severely impact quality of life in menopausal women. - The primary goal of using HRT is to manage these **menopausal symptoms** when they are bothersome. *Post menopausal bleeding* - **Postmenopausal bleeding** is a contraindication, not an indication, for new HRT initiation as it requires investigation to rule out endometrial pathology, including cancer. - If a woman on HRT experiences bleeding, it warrants immediate investigation to determine its cause and may necessitate stopping or changing the HRT regimen. *Cardiovascular protection* - While earlier beliefs suggested HRT offered cardiovascular protection, current evidence, particularly from the **Women's Health Initiative (WHI) study**, showed that HRT does not provide primary or secondary cardiovascular protection. - In fact, HRT may increase the risk of **cardiovascular events** like stroke and venous thromboembolism, especially when initiated many years after menopause. *Pyelonephritis* - **Pyelonephritis** is an infection of the kidney, typically caused by bacteria, and is not directly related to menopausal symptoms or hormonal status. - Treatment for pyelonephritis involves **antibiotics** and supportive care, not HRT.
Question 22: Which among the following is not a premalignant lesion of vulva?
- A. Paget's disease
- B. Bacterial Vaginosis (Correct Answer)
- C. Bowen's disease
- D. Lichen Sclerosus
Explanation: ***Bacterial Vaginosis*** - This is a common **vaginal infection** caused by an imbalance of normal vaginal bacteria, characterized by specific symptoms like increased discharge and odor. - Bacterial vaginosis is not considered a premalignant lesion and does not increase the risk of developing vulvar cancer. *Paget's disease* - This is a rare form of intraepithelial adenocarcinoma that can occur on the vulva, presenting as a red, itchy, scaly rash. - While it is a **carcinoma in situ**, it has the potential to become invasive, thus considered a premalignant or pre-invasive condition. *Bowen's disease* - This is a form of **squamous cell carcinoma in situ (SCCIS)**, typically appearing as a slow-growing, red, scaly patch on the skin. - It is considered a premalignant lesion because it can progress to invasive squamous cell carcinoma if left untreated. *Lichen Sclerosus* - This is a chronic inflammatory skin condition primarily affecting the anogenital region, leading to thinning, whitening, and scarring of the skin. - Although it is a benign condition, individuals with vulvar lichen sclerosus have an increased risk (3-5%) of developing **vulvar squamous cell carcinoma**, making it a premalignant condition.
Question 23: In uterine prolapse, how do you assess if a pessary ring is properly in place?
- A. If Bleeding does not occur
- B. If patient feels discomfort
- C. If not expelled after increased abdominal pressure (Correct Answer)
- D. None of the options
Explanation: ***If not expelled after increased abdominal pressure*** - A properly fitted pessary should remain in place even with increased **intra-abdominal pressure**, such as during coughing, straining, or Valsalva maneuvers, indicating stable support for the uterus. - This assesses the pessary's ability to mechanically support the **pelvic organs** and prevent prolapse recurrence during daily activities. *If Bleeding does not occur* - While bleeding after pessary insertion can indicate trauma or irritation, the absence of bleeding alone does not confirm proper fit or efficacy in preventing **prolapse**. - Bleeding can occur due to various reasons, and it is not a direct measure of the pessary's ability to maintain its position or provide support. *If patient feels discomfort* - Discomfort can indicate either an improperly fitted pessary (too large causing pressure, or too small causing rubbing) or an initial adjustment period. - However, the absence of discomfort does not guarantee the pessary will stay in place during activities that increase **abdominal pressure**, which is crucial for prolapse management. *None of the options* - This option is incorrect because the ability of the pessary to remain in place during increased abdominal pressure is a key indicator of its proper fit and effectiveness.