NEET-PG 2012 - Obstetrics and Gynecology Practice Questions

Q: Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Most common is ascending infection. ***Most common is ascending infection*** - Uterine tuberculosis is overwhelmingly due to **hematogenous spread** from a primary site, often the lungs, rather than an ascending infection from the lower genital tract. - Tuberculosis typically reaches the female genital tract by the **bloodstream**, with the fallopian tubes being the most common initial site of involvement. *Mostly secondary* - Genital tuberculosis, including uterine involvement, is almost always a **secondary infection**, meaning it results from the spread of Mycobacterium tuberculosis from another primary site in the body, most commonly the lungs. - The initial infection establishes elsewhere, and then the bacteria **disseminate hematogenously** to the reproductive organs. *Increase incidence of ectopic pregnancy* - Tubal damage and scarring caused by tuberculosis, particularly in the fallopian tubes (**salpingitis**), disrupt the normal passage of the ovum. - This anatomical alteration significantly **increases the risk** of the fertilized egg implanting outside the uterus, leading to ectopic pregnancy. *Involvement of endosalpinx* - The **fallopian tubes (endosalpinx)** are the most common site of genital tuberculosis, with eventual spread to the uterus through the lymphatic system or direct extension. - Tubal involvement can lead to **salpingitis isthmica nodosa** and hydrosalpinx, contributing to infertility and ectopic pregnancy.

Q: What is the primary use of prophylactic methergin?

To stop excess bleeding from uterus. ***To stop excess bleeding from uterus*** - **Methergin (Methylergonovine)** is an **ergot alkaloid** that causes strong contractions of the **uterus**. - Its primary prophylactic use is to **prevent or treat postpartum hemorrhage** by contracting the uterus and compressing blood vessels. *Induction of labour* - **Methergin** is generally **contraindicated for labor induction** as its potent, sustained contractions can cause **hypertonic uterine dysfunction** and fetal distress. - **Oxytocin** is the preferred agent for **labor induction** due to its more physiological contraction pattern. *Induction of abortion* - While methergin can cause uterine contractions, it is **not the primary agent for abortion induction**. - **Prostaglandins (e.g., misoprostol)** and other pharmacological agents are typically used in combination for **medical abortion**. *None of the options* - This option is incorrect because **stopping excess uterine bleeding** is indeed a primary use of prophylactic methergin, particularly in the postpartum period. - The other options describe situations where methergin is either not indicated or is a secondary/contraindicated choice.

Q: What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?

Contracted pelvis. ***Contracted pelvis*** - A **contracted pelvis** means the maternal pelvic dimensions are too small to allow for the safe passage of the fetus, making a vaginal birth impossible or highly risky. - This **fetopelvic disproportion** (cephalopelvic disproportion) necessitates a C-section to prevent obstructed labor, fetal distress, and potential harm to both mother and baby. - A contracted pelvis is a **definitive indication** for LSCS as vaginal delivery is contraindicated. *Mento anterior presentation* - In a **mento anterior presentation**, the fetal chin (mentum) is anterior, which is a **favorable position** for vaginal delivery as it allows for proper neck extension and engagement. - This presentation does not typically require a C-section unless there are other complicating factors. *Occipito posterior presentation* - While an **occipito posterior presentation** can sometimes lead to prolonged labor or the need for instrumental delivery, it is **not an absolute indication** for C-section. - Many cases can still deliver vaginally, either spontaneously or with rotation, and surgical intervention is usually reserved for failure to progress or fetal distress. *Vertex presentation* - A **vertex presentation** means the fetal head is flexed and presenting first, which is the **most common and ideal presentation** for a vaginal birth. - This presentation is a sign of a normal, potentially uncomplicated delivery and is the opposite of an indication for C-section.

Q: All are causes of anovulatory amenorrhea except which of the following?

Gonadal dysgenesis. ***Gonadal dysgenesis*** - This condition is a cause of **primary ovarian insufficiency**, leading to amenorrhea but not primarily due to anovulation in a previously cycling individual. - In gonadal dysgenesis, the **ovaries are malformed or absent**, resulting in a lack of follicles and thus no ovulation or estrogen production from the start. *PCOD* - **Polycystic Ovarian Disease** (PCOD/PCOS) is a common cause of anovulatory amenorrhea, characterized by **oligo- or anovulation**, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound. - The hormonal imbalance (e.g., elevated **androgens**, high **LH/FSH ratio**) disrupts normal follicular development and ovulation. *Hyperprolactinemia* - **Elevated prolactin levels** inhibit the pulsatile secretion of **GnRH (Gonadotropin-Releasing Hormone)** from the hypothalamus, which in turn reduces FSH and LH release from the pituitary. - This suppression of gonadotropins leads to impaired follicular development and **anovulation**, resulting in amenorrhea. *Drugs* - Various medications can cause anovulatory amenorrhea by interfering with the **hypothalamic-pituitary-ovarian axis**. - Examples include antipsychotics (which can increase **prolactin levels**), certain antidepressants, opioids, and chemotherapy agents that can damage ovarian function.

Q: Which of the following statements about the postmenopausal state is false?

Low LH. ***Low LH*** - This statement is **FALSE** because **LH (luteinizing hormone) levels are markedly elevated** in postmenopausal women. - The drop in ovarian estrogen production removes the **negative feedback** on the pituitary, leading to **increased LH and FSH secretion**. - Both gonadotropins (LH and FSH) are characteristically **high in postmenopause**. *High FSH* - This statement is true; **FSH (follicle-stimulating hormone) levels are markedly elevated** in postmenopausal women. - The elevated FSH is a direct consequence of the **lack of negative feedback** from inhibin and estrogen produced by the ovaries. *Low estrogen* - This statement is true; **estrogen levels plummet significantly** after menopause due to the **cessation of ovarian follicular activity**. - This **estrogen deficiency** is responsible for many postmenopausal symptoms, such as hot flashes, vaginal atrophy, and bone loss. *High androgen* - While androgens are still produced by the adrenal glands and ovaries postmenopause, their **absolute levels also decline with age**. - The statement is somewhat ambiguous, but androgens do **not increase** in absolute terms; rather, the **estrogen-to-androgen ratio changes** because estrogen falls more dramatically.

Q: A 35-year-old woman presents with 4 months of amenorrhea, increased FSH, LH, and decreased estrogen. What is the most likely diagnosis?

Premature ovarian insufficiency. ***Premature ovarian insufficiency (POI)*** - The patient's age (35 years) combined with 4 months of **amenorrhea**, increased **FSH** and **LH**, and decreased **estrogen** is characteristic of premature ovarian insufficiency (also called premature ovarian failure). - The hormonal profile (**hypergonadotropic hypogonadism**) indicates ovarian failure occurring before the age of **40 years**, which defines POI. - POI affects approximately **1% of women under 40** and can present with amenorrhea, infertility, and symptoms of estrogen deficiency. *Menopause* - Menopause is diagnosed after **12 consecutive months of amenorrhea** in a woman, typically occurring around age **51 years** (natural menopause). - While the hormonal profile of elevated FSH/LH and low estrogen is consistent with menopause, the patient's **age of 35 years** and **only 4 months of amenorrhea** do not meet the criteria for natural menopause. *Late menopause* - Late menopause refers to menopause occurring at a later age than average, typically after age **55 years**. - This diagnosis is completely inconsistent with the patient's age of 35 years. *Perimenopause* - Perimenopause is the transitional phase leading up to menopause, characterized by **irregular menstrual cycles** and **fluctuating hormone levels**. - While FSH levels may be elevated at times, perimenopause typically shows **variable hormone levels** rather than the sustained pattern of high FSH/LH with low estrogen seen in this case. - The **sustained amenorrhea** and pronounced hormonal shifts indicate ovarian failure (POI) rather than perimenopausal transition.

Q: Which of the following statements about the contraction stress test (CST) is MOST accurate?

Negative test is associated with good fetal outcome. ***Negative test is associated with good fetal outcome*** - A **negative CST** indicates that there are no late or significant variable decelerations in response to uterine contractions, suggesting the fetus can tolerate labor. - This finding is strongly correlated with **fetal well-being** and a low likelihood of fetal distress in the near future, with a **negative predictive value of approximately 99%**. *Invasive method* - The CST is considered a **non-invasive test**, as it involves external monitoring of fetal heart rate and uterine contractions. - No instruments are inserted into the body, differentiating it from truly invasive procedures like **amniocentesis**. *Detects fetal well being* - While the CST provides valuable information, it specifically assesses **uteroplacental function and fetal oxygenation reserve** during the stress of contractions, rather than comprehensive fetal well-being. - It identifies fetuses at risk for **uteroplacental insufficiency** but does not evaluate other parameters of fetal health. - Other tests like the **biophysical profile** offer a more comprehensive assessment of fetal well-being, including parameters like fetal breathing, movement, tone, and amniotic fluid volume. *Oxytocin is never used in the test* - **Oxytocin** is frequently used to induce uterine contractions if spontaneous contractions are insufficient for the test (oxytocin challenge test or OCT). - Alternatively, **nipple stimulation** can be used to achieve adequate contractions for the CST.

Q: Cardiac output increases maximum at which week?

30-32 wks. ***30-32 wks*** - **Cardiac output** in healthy pregnant women typically reaches its maximum increase of **30-50%** above pre-pregnancy levels between **28 and 32 weeks** of gestation. - This peak output is sustained until term, primarily driven by a significant increase in **stroke volume** and a moderate increase in **heart rate**. *26-28 wks* - While cardiac output steadily rises throughout pregnancy, the **peak increase** is generally not observed as early as **26-28 weeks**. - At this stage, the increase is substantial but is still progressing towards its **maximum point**. *32-34 wks* - The maximal cardiac output is usually achieved **before** this period, typically by **32 weeks**. - From **32 weeks** onwards, cardiac output tends to **plateau**, not increase further. *34-36 wks* - By **34-36 weeks**, cardiac output has generally already reached its peak and **stabilized**. - There is typically no further increase in cardiac output during this timeframe; rather, it is maintained at its maximal level.

Q: Least common presentation of twins?

Both transverse. ***Correct: Both transverse*** - A **transverse lie** means both fetuses are positioned horizontally across the uterus - This is the **rarest twin presentation**, occurring in approximately **0.5% of twin pregnancies** - The limited uterine space and natural tendency of fetuses to settle into longitudinal positions makes this presentation exceptionally uncommon - **Management**: Requires cesarean delivery due to impossibility of vaginal birth with both twins transverse *Incorrect: Both breech* - **Breech presentation** (feet or buttocks first) is more common in twin pregnancies than in singletons - Occurs in approximately **5-10% of twin pregnancies** - While complicated, both twins being breech is **significantly more common** than both transverse *Incorrect: First vertex and 2nd transverse* - The **first twin being cephalic (vertex)** is the most favorable and common position - The **second twin presenting transversely** can occur after delivery of the first twin when increased intrauterine space allows position change - This combination is **more common than both transverse** but requires careful management of the second twin *Incorrect: Both vertex* - **Vertex presentation for both twins** (both head-down) is the **most common presentation**, occurring in **40-45% of twin pregnancies** - This is the **optimal presentation for vaginal delivery** - Offers the best outcomes with lowest intervention rates

Q: What is the most common site for ectopic pregnancies?

Ampulla. ***Ampulla*** - The **ampulla** of the fallopian tube is the most common site for ectopic pregnancies, accounting for about **70-80% of all cases**. - Its **wider lumen** and **tortuous path** can delay the ovum's transit, increasing the likelihood of implantation there. *Isthmus* - The **isthmus** is the second most common site for ectopic pregnancies, accounting for about **12% of cases**. - Pregnancies in this narrow, muscular part of the tube are more prone to **early rupture** due to limited distensibility. *Fimbriae* - **Fimbrial** ectopic pregnancies are rare, accounting for approximately **5% of cases**. - These occur when the fertilized egg implants on the **finger-like projections** at the end of the fallopian tube. *Interstitial/Cornual* - **Interstitial** or **cornual** pregnancies are uncommon but serious, making up about **2-4% of ectopic pregnancies**. - They occur in the portion of the fallopian tube that passes through the **muscular wall of the uterus** and carry a higher risk of hemorrhage due to rich vascularity.

Question 1

Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Accepted Answer

Most common is ascending infection

Answer

Increase incidence of ectopic pregnancy

Answer

Involvement of endosalpinx

Answer

Mostly secondary

Question 2

What is the primary use of prophylactic methergin?

Accepted Answer

To stop excess bleeding from uterus

Answer

None of the options

Answer

Induction of labour

Answer

Induction of abortion

Question 3

What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?

Accepted Answer

Contracted pelvis

Answer

Mento anterior presentation

Answer

Occipito posterior presentation

Answer

Vertex presentation

Question 4

All are causes of anovulatory amenorrhea except which of the following?

Accepted Answer

Gonadal dysgenesis

Answer

Hyperprolactinemia

Answer

Drugs

Answer

PCOD

Question 5

Which of the following statements about the postmenopausal state is false?

Accepted Answer

Low LH

Answer

High FSH

Answer

Low estrogen

Answer

High androgen

Question 6

A 35-year-old woman presents with 4 months of amenorrhea, increased FSH, LH, and decreased estrogen. What is the most likely diagnosis?

Accepted Answer

Premature ovarian insufficiency

Answer

Menopause

Answer

Late menopause

Answer

Perimenopause

Question 7

Which of the following statements about the contraction stress test (CST) is MOST accurate?

Accepted Answer

Negative test is associated with good fetal outcome

Answer

Invasive method

Answer

Detects fetal well being

Answer

Oxytocin is never used in the test

Question 8

Cardiac output increases maximum at which week?

Accepted Answer

30-32 wks

Answer

26-28 wks

Answer

34-36 wks

Answer

32-34 wks

Question 9

Least common presentation of twins?

Accepted Answer

Both transverse

Answer

Both breech

Answer

First vertex and 2nd transverse

Answer

Both vertex

Question 10

What is the most common site for ectopic pregnancies?

Accepted Answer

Ampulla

Answer

Isthmus

Answer

Fimbriae

Answer

Interstitial/Cornual

NEET-PG 2012 — Obstetrics and Gynecology