Which of the following statements about Asherman's syndrome is true?
Gold standard technique for diagnosis of endometriosis?
What is the investigation of choice in postmenopausal bleeding?
Which IUD is preferred for menorrhagia?
In which scenario is the I-pill (emergency contraceptive) most appropriately used?
Vaginal pH before puberty is?
What is the treatment of choice for Bartholin's cyst?
Nuchal translucency is used in
Caput succedaneum indicates that the fetus was alive until which point?
A 35 year old female with history of repeated D&C now has secondary amenorrhea. What is your diagnosis?
NEET-PG 2012 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 21: Which of the following statements about Asherman's syndrome is true?
- A. May be secondary to TB
- B. Progesterone challenge test is positive
- C. Characterized by intrauterine adhesions (Correct Answer)
- D. Not associated with menstrual irregularities
Explanation: ***Characterized by intrauterine adhesions*** - **Asherman's syndrome** is fundamentally defined by the presence of **intrauterine adhesions** or scarring of the uterine cavity. - These adhesions develop following trauma to the basal layer of the endometrium, often from gynecological procedures like **dilation and curettage (D&C)**. - This is the **pathognomonic feature** that defines the syndrome. *Progesterone challenge test is positive* - The **progesterone challenge test** assesses the presence of an intact endometrium and adequate estrogen priming. - In Asherman's syndrome, due to the scarred endometrium, the response to progesterone is typically **absent or minimal**, leading to a **negative** result. - A negative progesterone challenge test indicates outflow obstruction or endometrial non-responsiveness. *May be secondary to TB* - While **genital tuberculosis** can cause intrauterine adhesions and is a recognized etiology, it represents a **small minority** of cases. - The primary etiology of Asherman's syndrome is usually **iatrogenic**, following uterine instrumentation such as D&C, particularly post-partum or post-abortion. - TB-related adhesions may have additional features like caseating granulomas. *Not associated with menstrual irregularities* - This is **false** - Asherman's syndrome is classically associated with **menstrual irregularities**. - Common presentations include **hypomenorrhea** (scanty periods), **amenorrhea** (absent periods), or oligomenorrhea. - These menstrual changes result from the reduced functional endometrium available for cyclical shedding due to intrauterine adhesions.
Question 22: Gold standard technique for diagnosis of endometriosis?
- A. Ca 125 level
- B. Ultrasound
- C. MRI
- D. Laparoscopy (Correct Answer)
Explanation: ***Laparoscopy*** - **Laparoscopy** allows for direct visualization of endometrial implants and enables **biopsy confirmation**, making it the gold standard. - This minimally invasive surgical procedure is crucial for diagnosing, staging, and often treating endometriosis simultaneously. *Ca 125 level* - **CA-125** is a serum marker that can be elevated in endometriosis, but it is **not specific** and can be raised in other conditions like ovarian cancer or physiologic states. - It is primarily used for monitoring treatment response or recurrence, rather than as a primary diagnostic tool. *Ultrasound* - **Transvaginal ultrasound (TVS)** can identify endometriomas (chocolate cysts) and deep infiltrating endometriosis, but it cannot reliably visualize small peritoneal implants. - While it's a good initial imaging modality, its sensitivity for diagnosing all forms of endometriosis is **limited**. *MRI* - **MRI** offers better soft tissue contrast than ultrasound and can identify deep infiltrating endometriosis and some peritoneal implants, especially those involving the bowel or bladder. - However, MRI is **more expensive** and less accessible, and it still cannot definitively rule out all small, superficial endometrial lesions without direct visualization.
Question 23: What is the investigation of choice in postmenopausal bleeding?
- A. PAP smear
- B. Laparoscopy
- C. Fractional curettage
- D. Ultrasound (Correct Answer)
Explanation: ***Ultrasound*** - An initial **transvaginal ultrasound** is the investigation of choice to assess the endometrial thickness in postmenopausal bleeding. An endometrial thickness of >4-5mm often warrants further investigation. - It helps in **ruling out endometrial pathologies** like hyperplasia, polyps, or carcinoma. *PAP smear* - A **PAP smear** is a screening test for cervical cancer, not typically used to investigate postmenopausal bleeding originating from the uterus. - While it can detect some endometrial cells, it is **not sensitive** or specific enough to diagnose the cause of postmenopausal bleeding. *Laparoscopy* - **Laparoscopy** is a surgical procedure used to visualize pelvic organs and is generally employed for diagnosing and treating conditions like endometriosis, ovarian cysts, or ectopic pregnancies. - It is **not the initial investigation** for postmenopausal bleeding and is too invasive for primary diagnosis unless other methods have failed or a specific pathology is suspected. *Fractional curettage* - **Fractional curettage** involves scraping the lining of the cervix and uterus to obtain tissue samples for histological examination. - While it can be diagnostic for endometrial pathology, it is typically performed **after an initial ultrasound** has identified increased endometrial thickness or other suspicious findings, and less commonly as a standalone initial investigation.
Question 24: Which IUD is preferred for menorrhagia?
- A. NOVA T
- B. Cu IUD
- C. Mirena (Correct Answer)
- D. Gynefix
Explanation: ***Mirena*** - The **Mirena** IUD contains **levonorgestrel**, a progestin, which significantly reduces menstrual blood loss by causing endometrial atrophy. - It is FDA-approved for the treatment of **menorrhagia** and is highly effective in reducing heavy menstrual bleeding. *NOVA T* - **NOVA T** is a **copper IUD**, which can actually *increase* menstrual blood loss and dysmenorrhea, making it unsuitable for menorrhagia. - Copper IUDs work primarily by inducing a **local inflammatory reaction** in the uterus that is spermicidal and prevents fertilization. *Cu IUD* - Like NOVA T, **copper IUDs (Cu IUDs)** are known to exacerbate **heavy menstrual bleeding** and cramping. - They are used for contraception but are generally contraindicated in women with pre-existing menorrhagia. *Gynefix* - **Gynefix** is a frameless copper IUD designed to reduce the side effects of traditional T-shaped copper IUDs. - While it may cause less cramping than other copper IUDs, it still contains copper and can **increase menstrual flow**, making it a poor choice for menorrhagia.
Question 25: In which scenario is the I-pill (emergency contraceptive) most appropriately used?
- A. When a contraceptive method fails
- B. After unprotected sexual intercourse
- C. As a regular contraceptive method
- D. In case of contraceptive failure or unprotected sex (Correct Answer)
Explanation: ***In case of contraceptive failure or unprotected sex*** - This is the **most comprehensive and appropriate answer** as it covers **both major indications** for emergency contraception. - The **I-pill (levonorgestrel)** is indicated when there has been unprotected intercourse OR when a contraceptive method has failed (e.g., condom breakage, missed pills, dislodged IUD). - It should be taken as soon as possible, ideally within **72 hours** of the event, though it can be used up to 120 hours with reduced efficacy. - This option correctly encompasses the full scope of emergency contraception use. *After unprotected sexual intercourse* - While this is a **valid indication**, it only covers one scenario and is not as comprehensive as the correct answer. - This option misses situations of contraceptive failure where intercourse was technically "protected" but the method failed. *When a contraceptive method fails* - This is also a **valid indication** but only covers contraceptive accidents (condom breakage, missed pills). - It excludes situations where no contraceptive was used at all. - Like the previous option, it is incomplete compared to the correct answer. *As a regular contraceptive method* - The I-pill is **not intended for routine contraception** due to higher hormone doses and lower efficacy compared to regular methods. - It has a higher side effect profile with frequent use and does not protect against sexually transmitted infections. - Emergency contraception should only be used occasionally in emergency situations.
Question 26: Vaginal pH before puberty is?
- A. Approximately 6
- B. Approximately 4.5
- C. Approximately 5
- D. Neutral (around 7) (Correct Answer)
Explanation: ***Neutral (around 7)*** - Before puberty, the vagina lacks the influence of **estrogen**, which is essential for the colonization of **Lactobacillus** bacteria. - Without Lactobacillus, there is no significant production of lactic acid, resulting in a **neutral pH** environment. *Approximately 6* - A pH of approximately 6 is still slightly acidic but less so than a mature vagina. - This value is not typical for the prepubertal stage, which generally represents an environment without significant acidic production. *Approximately 4.5* - A pH of approximately 4.5 is characteristic of a **healthy, estrogenized adult vagina** where **Lactobacillus** bacteria produce lactic acid. - This acidic environment is crucial for protecting against pathogenic infections and is not found in prepubertal individuals. *Approximately 5* - A pH of approximately 5 is acidic, though less so than the optimal adult vaginal pH. - This value indicates some lactic acid production, which is minimal or absent before the onset of puberty.
Question 27: What is the treatment of choice for Bartholin's cyst?
- A. Excision
- B. Antibiotic therapy
- C. Marsupialization (Correct Answer)
- D. Cyst drainage
Explanation: ***Marsupialization*** - This procedure involves incising the cyst, draining its contents, and then everting and suturing the edges of the cyst wall to the surrounding skin, creating a permanent-draining pouch. - **Marsupialization** is the treatment of choice because it prevents recurrence by allowing continuous drainage of mucus, unlike simple incision and drainage. *Excision* - Complete surgical excision of the Bartholin's gland or cyst is a more invasive procedure and is typically reserved for cases of **recurrent cysts** after marsupialization or suspected malignancy. - It carries a higher risk of bleeding and infection compared to marsupialization, and can lead to **vaginal dryness** due to loss of glandular secretions. *Antibiotic therapy* - Antibiotics are primarily used if the Bartholin's gland becomes **infected**, leading to an **abscess**, or if there is surrounding cellulitis. - They do not address the underlying blockage of the duct and will not resolve a Bartholin's cyst, which is a collection of mucus due to duct obstruction. *Cyst drainage* - Simple incision and drainage (I&D) provides temporary relief by emptying the cyst contents but has a **high recurrence rate** because the duct often re-occludes. - While it may be used as an initial temporizing measure, it is not the definitive treatment for preventing future episodes of Bartholin's cysts.
Question 28: Nuchal translucency is used in
- A. Head scan
- B. MRI neck
- C. ANC USG (Correct Answer)
- D. Anthropometry
Explanation: ***ANC USG*** - **Nuchal translucency** measurement is a key component of the **first-trimester antenatal ultrasound** (ANC USG). - It helps in screening for chromosomal abnormalities like **Down syndrome (Trisomy 21)** and certain cardiac defects. *Head scan* - A head scan (e.g., CT or MRI of the head) is used to evaluate the **brain** and **skull** for conditions like tumors, strokes, or trauma. - It is not routinely used for fetal screening or nuchal translucency assessment. *MRI neck* - **MRI of the neck** is employed to visualize soft tissues, blood vessels, and bones in the neck region. - Its primary use is in diagnosing conditions like cervical disc herniations, spinal cord compression, or neck masses, not for fetal screening. *Anthropometry* - **Anthropometry** involves the measurement of the human body, such as height, weight, and limb circumference. - While general measurements are taken during pregnancy, anthropometry specifically does not refer to the assessment of nuchal translucency.
Question 29: Caput succedaneum indicates that the fetus was alive until which point?
- A. Immediately after birth (Correct Answer)
- B. Till 2-3 days after birth
- C. 2-3 weeks after birth
- D. 2-3 months after birth
Explanation: ***Immediately after birth*** - **Caput succedaneum** is a benign condition characterized by a **diffuse, edematous swelling** of the fetal scalp, crossing suture lines. - It results from pressure on the fetal head during vertex delivery, causing **extravasation of fluid** into the subcutaneous tissue, indicating the fetus was alive and circulating blood until birth. *Till 2-3 days after birth* - This option is incorrect because **caput succedaneum** is a direct consequence of the **birthing process** itself, forming during labor and delivery. - The presence of this scalp swelling signifies that the baby was alive and experienced the forces of birth, not that it survived for several days afterward. *2-3 weeks after birth* - This option is incorrect as **caput succedaneum** typically resolves within a few days of birth. - Its presence is a temporary finding related to the immediate perinatal period and does not indicate survival for several weeks. *2-3 months after birth* - This option is incorrect because **caput succedaneum** is a transient condition appearing at birth and usually disappearing within a few days. - It has no implication for the baby's survival beyond the immediate postnatal period, let alone for several months.
Question 30: A 35 year old female with history of repeated D&C now has secondary amenorrhea. What is your diagnosis?
- A. Asherman's syndrome (Correct Answer)
- B. Hypothyroidism
- C. Kallman syndrome
- D. Sheehan's syndrome
Explanation: ***Asherman's syndrome*** - This syndrome is characterized by the formation of **intrauterine adhesions** or scar tissue following uterine trauma, often from repeated **Dilation and Curettage (D&C)** procedures. - The adhesions can prevent the normal growth and shedding of the **endometrial lining**, leading to **secondary amenorrhea** and infertility. *Hypothyroidism* - While hypothyroidism can cause menstrual irregularities, including **amenorrhea**, it would not typically be linked to a history of **repeated D&C procedures**. - The mechanism involves **hormonal imbalances** (e.g., elevated **TRH leading to elevated prolactin**), not scarring of the uterus. *Kallman syndrome* - This is a rare genetic condition causing **hypogonadotropic hypogonadism** and **anosmia** (loss of smell), leading to **primary amenorrhea**. - It does not involve uterine scarring and is not associated with D&C procedures or **secondary amenorrhea**. *Sheehan's syndrome* - Sheehan's syndrome is **postpartum hypopituitarism** caused by **ischemic necrosis of the pituitary gland** after severe hemorrhage during or after childbirth. - It would present with symptoms like **lactation failure** and could cause **secondary amenorrhea**, but it is not related to repeated D&C procedures.