NEET-PG 2018 - Obstetrics and Gynecology Practice Questions

Q: Which of the following is an indication for use of Hormone Replacement Therapy in menopausal women:-

Hot flushes. ***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.

Q: Which among the following is not a premalignant lesion of vulva?

Bacterial Vaginosis. ***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.

Q: In uterine prolapse, how do you assess if a pessary ring is properly in place?

If not expelled after increased abdominal pressure. ***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.

Q: Which one of the following is implicated in the etiology of these adhesions around the liver?

Chlamydial infection. ***Chlamydial infection*** - The image shows **Fitz-Hugh-Curtis syndrome**, characterized by **violin-string adhesions** visible between the liver capsule and the parietal peritoneum. - This condition is a perihepatitis that occurs as a complication of **pelvic inflammatory disease (PID)**, most commonly caused by **Chlamydia trachomatis** or Neisseria gonorrhoeae. *Perforation of dermoid cyst* - A perforated dermoid cyst (mature cystic teratoma) typically causes a **chemical peritonitis** due to the leakage of sebaceous material, hair, and other contents. - While it can lead to adhesions, these are usually diffuse and not specifically the **violin-string type perihepatic adhesions** characteristic of Fitz-Hugh-Curtis syndrome. *Pseudomyxoma peritonei* - Pseudomyxoma peritonei is characterized by the accumulation of **gelatinous ascites** and mucin-producing tumor cells in the peritoneal cavity, often originating from a ruptured appendiceal mucinous neoplasm. - It results in widespread mucinous deposits and adhesions, which are distinct from the fibrous, violin-string adhesions around the liver seen in the image. *Liver metastases in ovarian cancer* - Liver metastases from ovarian cancer would appear as **nodular lesions within the liver parenchyma** or on its surface, not as fibrous adhesions between the liver and abdominal wall. - While ovarian cancer can cause ascites and peritoneal carcinomatosis, the presentation of **perihepatic adhesions** in the image is not typical for direct metastatic spread to the liver surface in this manner.

Question 1

Which of the following is an indication for use of Hormone Replacement Therapy in menopausal women:-

Accepted Answer

Hot flushes

Answer

Post menopausal bleeding

Answer

Cardiovascular protection

Answer

Pyelonephritis

Question 2

Which among the following is not a premalignant lesion of vulva?

Accepted Answer

Bacterial Vaginosis

Answer

Paget's disease

Answer

Bowen's disease

Answer

Lichen Sclerosus

Question 3

In uterine prolapse, how do you assess if a pessary ring is properly in place?

Accepted Answer

If not expelled after increased abdominal pressure

Answer

If Bleeding does not occur

Answer

If patient feels discomfort

Answer

None of the options

Question 4

Which one of the following is implicated in the etiology of these adhesions around the liver?

Accepted Answer

Chlamydial infection

Answer

Perforion of dermoid cyst

Answer

Pseudomyxoma peritonei

Answer

Liver metastases in ovarian cancer

NEET-PG 2018 — Obstetrics and Gynecology