NEET-PG 2019 - Obstetrics and Gynecology Practice Questions

Q: Which of the following statement is correct about acute fatty liver of pregnancy?

Mostly seen in last trimester. ***Mostly seen in last trimester*** - **Acute fatty liver of pregnancy (AFLP)** typically manifests in the **third trimester** (weeks 28-40) of gestation or in the immediate postpartum period. - This timing is due to the increased metabolic demands on the liver during late pregnancy, which can exacerbate underlying defects in mitochondrial fatty acid oxidation. *Occurs in 1 in 1000 pregnancies* - AFLP is a **rare** obstetric complication, occurring in approximately **1 in 7,000 to 1 in 16,000** pregnancies, not 1 in 1000. - The incidence of 1 in 1000 would make it far too common and is incorrect. *Not related to the gender of the fetus* - AFLP has been observed to have a higher incidence in pregnancies involving a **male fetus**. - This association is thought to be related to differences in fetal steroid metabolism or the demands placed on maternal liver function by the male fetus. *May be associated with decreased uric acid* - AFLP is typically associated with **elevated serum uric acid levels** (hyperuricemia), not decreased levels. - Other typical findings include elevated liver enzymes, bilirubin, and sometimes severe hypoglycemia.

Q: PGF2 alpha maximum dose in PPH is-

2 mg. ***2 mg*** - The maximum recommended total dose of **PGF2 alpha** (Carboprost/Hemabate) for postpartum hemorrhage (PPH) is **2 mg**. - This limit is typically reached after administering eight doses of 250 µg each. *1000 µg* - This is equivalent to **1 mg**, which is only half of the maximum recommended total dose for PGF2 alpha in PPH. - While individual doses are 250 µg, the cumulative maximum dose is higher. *200 µg* - This dosage is **lower than the standard individual dose** of 250 µg for PGF2 alpha in PPH. - Administering only 200 µg would be suboptimal for managing severe hemorrhage. *20 mg* - This dose is **ten times the maximum recommended total dose** of 2 mg for PGF2 alpha. - Administering 20 mg could lead to severe adverse effects and toxicity.

Q: Hormone predominantly secreted after 14 days that acts on the endometrium is?

Progesterone. ***Progesterone*** - After **ovulation** (around day 14 of a typical 28-day cycle), the **corpus luteum** forms and begins secreting large amounts of progesterone. - Progesterone's primary role is to prepare the **endometrium** for potential implantation by making it secretory and vascularized. *Estrogen* - Estrogen levels are highest during the **proliferative phase** (days 1-14), promoting endometrial growth and thickening. - While present after day 14, its predominant role shifts to preparing the uterus, but not as the *main* hormone secreted to support the post-ovulatory endometrium. *LH (Luteinizing Hormone)* - LH is crucial for triggering **ovulation** itself, with a surge occurring just before day 14. - After ovulation, LH levels decrease and its primary role is not direct endometrial modification. *FSH (Follicle-Stimulating Hormone)* - FSH is primarily active in the **follicular phase** (days 1-14), stimulating ovarian follicle growth. - Its levels decrease after ovulation, and it does not directly regulate endometrial changes in the post-ovulatory period.

Q: Female with 41 wk gestation confirmed by radiological investigation, very sure of her LMP, no uterine contractions, no effacement and no dilatation. What should be done to induce labor?

PGE1 tab. ***PGE1 tab*** - **Misoprostol (PGE1)** is an effective agent for **cervical ripening** and labor induction in cases of an unfavorable cervix (no effacement, no dilatation). - It is cost-effective, stable at room temperature, and widely used in resource-limited settings. - Can be administered orally or vaginally with good efficacy for cervical ripening at term. - In this post-term pregnancy with unfavorable cervix, pharmacological ripening is appropriate. *PGE2 gel* - **PGE2 (dinoprostone)** gel or cervical insert is also an effective option for cervical ripening. - Both PGE1 and PGE2 are acceptable first-line agents; the choice may depend on availability, cost, and institutional protocols. - PGE2 formulations are FDA-approved and widely used, though may be more expensive than misoprostol. *PGF2alpha* - **PGF2alpha (carboprost)** is primarily used for the **management of postpartum hemorrhage** due to its potent myometrial contracting effect. - It is **not indicated** for induction of labor at term as its strong uterine contractions can cause excessive uterine stimulation and fetal distress. *Intracervical foley's* - An **intracervical Foley catheter** is a mechanical method that causes cervical ripening through direct pressure and stimulation of local prostaglandin release. - It is an evidence-based alternative with lower risk of uterine hyperstimulation compared to pharmacological methods. - Both mechanical and pharmacological methods are acceptable first-line options for cervical ripening in post-term pregnancy with unfavorable cervix.

Q: A lady primigravida developed fluctuant painful mass of breast and fever after 14 days of delivery. Preferred treatment option is:-

Incision and drainage. ***Incision and drainage*** - A **fluctuant, painful mass** in the breast combined with **fever** 14 days postpartum strongly indicates a **breast abscess**, which requires surgical drainage as the definitive treatment. - **I&D removes the pus collection** and is the preferred treatment for an established abscess, usually combined with **appropriate antibiotics** (though the primary intervention is drainage). - After drainage, breastfeeding can typically be **continued from the unaffected breast** while the affected side heals. *Analgesics and continue breast feeding* - While analgesics can relieve pain and continuing breastfeeding is appropriate for **simple mastitis**, these measures are **insufficient for an established abscess** with a fluctuant collection. - An abscess requires drainage; conservative management alone will not resolve a loculated pus collection. *Antipyretic* - An antipyretic will help reduce the **fever symptomatically**, but it does not address the underlying **purulent collection or infection**. - It would only mask symptoms without treating the cause, potentially delaying appropriate surgical intervention. *Stop lactation* - Stopping lactation abruptly can lead to **breast engorgement** and may worsen milk stasis, potentially complicating the infection. - While temporary cessation from the affected breast during acute infection might be considered, outright stopping lactation is **not the preferred primary treatment** for an abscess and may interfere with recovery.

Q: PGF2 alpha maximum dose in PPH management that can be given over 24 hours is:

2 mg. ***2 mg*** - The maximum recommended dose of **PGF2 alpha** (carboprost tromethamine) in a 24-hour period for PPH management is **2 mg**. - This is typically administered as 250 mcg (0.25 mg) intramuscularly every 15-90 minutes, with a total dose not exceeding 2 mg. *20 mg* - This dose is significantly higher than the recommended maximum for **PGF2 alpha** in PPH and would likely lead to severe adverse effects. - Exceeding the 2 mg limit can increase the risk of gastrointestinal, cardiovascular, and pulmonary complications. *200 mg* - This is an extremely high and dangerous dose of **PGF2 alpha**, far beyond any therapeutic range for PPH management. - Such a dose would almost certainly result in life-threatening complications. *250 mg* - While individual doses of **PGF2 alpha** are 250 mcg (0.25 mg), a total dose of 250 mg over 24 hours is vastly excessive. - This value likely confuses the single dose amount with a significantly larger incorrect total.

Question 1

Which of the following statement is correct about acute fatty liver of pregnancy?

Accepted Answer

Mostly seen in last trimester

Answer

May be associated with decreased uric acid

Answer

Occurs in 1 in 1000 pregnancies

Answer

Not related to the gender of the fetus

Question 2

PGF2 alpha maximum dose in PPH is-

Accepted Answer

2 mg

Answer

200 µg

Answer

20 mg

Answer

1000 µg

Question 3

Hormone predominantly secreted after 14 days that acts on the endometrium is?

Accepted Answer

Progesterone

Answer

Estrogen

Answer

LH

Answer

FSH

Question 4

Female with 41 wk gestation confirmed by radiological investigation, very sure of her LMP, no uterine contractions, no effacement and no dilatation. What should be done to induce labor?

Accepted Answer

PGE1 tab

Answer

PGE2 gel

Answer

PGF2alpha

Answer

Intracervical foley’s

Question 5

A lady primigravida developed fluctuant painful mass of breast and fever after 14 days of delivery. Preferred treatment option is:-

Accepted Answer

Incision and drainage

Answer

Analgesics and continue breast feeding

Answer

Antipyretic

Answer

Stop lactation

Question 6

PGF2 alpha maximum dose in PPH management that can be given over 24 hours is:

Accepted Answer

2 mg

Answer

20 mg

Answer

200 mg

Answer

250 mg

NEET-PG 2019 — Obstetrics and Gynecology