INI-CET 2023 - Obstetrics and Gynecology PYQs Practice Questions

Q: Which of the following is an established benefit of Hormone Replacement Therapy (HRT)?

Decreased risk of vertebral fracture. ***Decreased risk of vertebral fracture*** - HRT is **one of the most well-established benefits** for **prevention of osteoporosis and fractures**, including vertebral fractures. - Estrogen plays a crucial role in maintaining **bone mineral density** by inhibiting osteoclast activity and promoting osteoblast function. - Multiple studies, including the **Women's Health Initiative (WHI)**, have demonstrated a **significant reduction in hip, vertebral, and other osteoporotic fractures** in women taking HRT. - This benefit is recognized by **ACOG, NAMS, and international menopause societies** as a primary indication for HRT in appropriate candidates. *Decreased risk of endometrial cancer* - **Unopposed estrogen therapy** actually **increases the risk of endometrial cancer** due to hyperplasia of the endometrium. - To counteract this, **progestin is added** in women with a uterus receiving HRT, which reduces but does not eliminate the risk increase. - Combined HRT does not provide a net decreased risk below baseline. *Decreased risk of breast cancer* - Combined **estrogen-progestin HRT** has been consistently associated with an **increased risk of breast cancer**, especially with longer durations of use (>5 years). - This was clearly demonstrated in the **WHI trial** and remains a major consideration when prescribing HRT. - Estrogen-only HRT might have a neutral or slightly increased risk, but never a decreased risk. *Decreased risk of colon cancer* - While some observational studies and the **WHI trial** initially showed a reduced incidence of colorectal cancer with HRT, this is **not considered an established or primary indication** for HRT. - Subsequent analyses have shown **inconsistent results**, and any benefit is offset by increased risks. - Current guidelines do **not recommend HRT** for colorectal cancer prevention. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A woman presents with painless ulcers on the vulva, she gives a history of having multiple sexual partners and has had a stillbirth at 28 weeks in the past. What is the next best step of investigation?

VDRL. ***VDRL*** - The presentation of **painless vulvar ulcers**, a history of **multiple sexual partners**, and a past **stillbirth at 28 weeks** are highly suggestive of **syphilis**. - A **VDRL (Venereal Disease Research Laboratory) test** is a non-treponemal serologic test used for screening and monitoring the treatment of syphilis. *PCR* - While **PCR** can be used to detect the genetic material of *Treponema pallidum*, it is not the primary diagnostic test for syphilis, especially given the classic clinical picture. - It is more commonly used for detecting other sexually transmitted infections (STIs) or for specific situations where direct detection of the organism from a lesion is preferred. *Vaginal swab and culture* - A **vaginal swab and culture** would be appropriate for diagnosing bacterial vaginosis, candidiasis, or certain bacterial STIs, but it is not suitable for diagnosing syphilis. - Syphilis is caused by a spirochete (*Treponema pallidum*) that cannot be cultured on standard media. *NAT* - **Nucleic Acid Amplification Tests (NATs)** are a broad category of tests that include PCR. - Like PCR, while potentially applicable for *Treponema pallidum* detection, they are not the standard or first-line diagnostic investigation for syphilis given the strong clinical indicators. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: All are the causes of non-immune hydrops except?

ABO incompatibility. ***ABO incompatibility*** - **ABO incompatibility** is a common cause of **immune hydrops fetalis** due to antibody-mediated hemolytic anemia. - Immune hydrops involves red blood cell destruction caused by maternal antibodies crossing the placenta, which is not characteristic of non-immune hydrops. *Thalassemia* - **Alpha-thalassemia major (Hb Barts hydrops fetalis)** is a severe form of thalassemia frequently leading to **non-immune hydrops** due to profound anemia. - The severe chronic anemia leads to **high-output cardiac failure**, diffuse edema, and ascites. *Cardiovascular causes* - **Structural heart defects** and **arrhythmias** can impair fetal circulation and cardiac function, leading to **non-immune hydrops**. - Conditions like **hypoplastic left heart syndrome** or **supraventricular tachycardia** can cause fluid overload and edema. *Parvovirus* - **Parvovirus B19 infection** in the fetus can cause severe **anemia** by targeting erythroid progenitor cells, resulting in bone marrow suppression. - This severe fetal anemia frequently leads to **non-immune hydrops** as a consequence of heart failure. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A patient has dyspareunia, and dysmenorrhea with adnexal tenderness. What is the first step of investigation?

Transvaginal USG. ***Transvaginal USG*** - This is the **first-line investigation** for evaluating pelvic pain, dyspareunia, dysmenorrhea, and adnexal tenderness due to its ability to provide **high-resolution images** of the uterus, ovaries, and surrounding structures to identify potential pathology like **endometriomas** or other adnexal masses. - It allows for detailed assessment of **ovarian cysts**, fibroids, and other pelvic abnormalities, which can explain the patient's symptoms. *Colposcopy* - This procedure is primarily used to closely examine the **cervix, vagina, and vulva** for abnormal cells, often following an abnormal Pap test. - It is not the initial step for investigating generalized pelvic pain, dyspareunia, or adnexal tenderness. *Diagnostic laparoscopy* - While a **diagnostic laparoscopy** can provide a definitive diagnosis for conditions like **endometriosis**, it is an **invasive surgical procedure** and typically reserved for cases where non-invasive imaging, such as transvaginal ultrasound, has not yielded a clear diagnosis or when conservative management has failed. - It is not considered the first-step investigation due to its **invasive nature** and associated risks. *Transabdominal pelvic ultrasound* - A **transabdominal pelvic ultrasound** provides a broader view of the pelvic organs but often has **lower resolution** and is less accurate for detailed assessment of the uterus, ovaries, and adnexa compared to transvaginal ultrasound, especially in obese patients. - It is often used if a transvaginal ultrasound is not feasible or for assessing larger pelvic masses, but the **transvaginal approach** is superior for detailed evaluation of the female reproductive organs. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

A 15-year-old girl child with primary amenorrhea has pubic hair, prepubertal breast, blind vagina, clitoromegaly, and normal testosterone. Karyotype given is 46 XY , what is the cause?

Accepted Answer

5-alpha reductase deficiency

Answer

17 hydroxylase deficiency

Answer

Swyer syndrome

Answer

Complete AIS

Question 2

Which of the following is an established benefit of Hormone Replacement Therapy (HRT)?

Accepted Answer

Decreased risk of vertebral fracture

Answer

Decreased risk of endometrial cancer

Answer

Decreased risk of breast cancer

Answer

Decreased risk of colon cancer

Question 3

A woman presents with painless ulcers on the vulva, she gives a history of having multiple sexual partners and has had a stillbirth at 28 weeks in the past. What is the next best step of investigation?

Accepted Answer

VDRL

Answer

PCR

Answer

Vaginal swab and culture

Answer

NAT

Question 4

All are the causes of non-immune hydrops except?

Accepted Answer

ABO incompatibility

Answer

Thalassemia

Answer

Cardiovascular causes

Answer

Parvovirus

Question 5

A patient has dyspareunia, and dysmenorrhea with adnexal tenderness. What is the first step of investigation?

Accepted Answer

Transvaginal USG

Answer

Colposcopy

Answer

Diagnostic laparoscopy

Answer

Transabdominal pelvic ultrasound

Question 6

After delivering a baby boy, a 25 -year-old mother developed acute PPH and hypovolemic shock, and major blood transfusion occurred. All of the following are complications of blood transfusion except?

Accepted Answer

Hypokalemia

Answer

Hypothermia

Answer

Hypocalcemia

Answer

Hypomagnesemia

Question 7

Least chance of perinatal transmission?

Accepted Answer

Hepatitis A

Answer

HSV

Answer

Rubella

Answer

CMV

Question 8

A 30-year-old pregnant female diagnosed with fibroid presented with fever, mild leukocytosis, and pain at 28 weeks. What is the likely cause?

Accepted Answer

Red degeneration of fibroid

Answer

Fibroid infection

Answer

Fibroid torsion

Answer

Labor pain

Question 9

A patient complained of whitish discharge from the vagina and yellow staining on their clothes. There is no itching, no redness, and pH is acidic. What is the likely cause?

Accepted Answer

Increased normal vaginal discharge

Answer

Trichomoniasis

Answer

Candidiasis

Answer

Bacterial vaginosis

Question 10

What are clue cells?

Accepted Answer

Vaginal epithelial cells lined by bacteria

Answer

Uterine epithelial cells lined by bacteria

Answer

Cervical epithelial cells lined by bacteria

Answer

Abdominal cells lined by bacteria

INI-CET 2023 — Obstetrics and Gynecology