Red degeneration of fibroid is seen in which of the following?
Which of the following statements about radical hysterectomy in stage Ib cervical cancer compared to radiotherapy is false?
A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?
Most common presentation of cervical cancer is -
What is the first-line treatment for simple hyperplasia of the endometrium?
What is the most common presenting feature of a complete mole?
Which condition is characterized by androgenesis (purely paternal genetic origin)?
In which part of the fallopian tube is there a high chance of rupture in a tubal pregnancy?
Most common site of ectopic pregnancy is -
What percentage of ectopic pregnancies occur in the fallopian tube?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 41: Red degeneration of fibroid is seen in which of the following?
- A. Early pregnancy
- B. Mid pregnancy (Correct Answer)
- C. Nulliparous women
- D. Puerperium
Explanation: ***Mid pregnancy*** - **Red degeneration**, or **carneous degeneration**, is most common during the **second and third trimesters of pregnancy** due to increased metabolic demands of the growing fibroid outstripping its blood supply. - The rapid growth leads to **ischemia**, hemorrhage, and necrosis within the fibroid, causing acute abdominal pain. *Early pregnancy* - While fibroids can grow in early pregnancy, **red degeneration** is less common as the uterine blood supply is generally still adequate to meet the fibroid's metabolic needs. - Other forms of degeneration, like **hyaline degeneration**, are more frequently observed in non-pregnant or early pregnant states. *Puerperium* - In the puerperium, fibroids typically undergo **regression** rather than degeneration, as the hormonal stimulation (estrogen and progesterone) that promoted their growth significantly decreases. - The uterus involutes rapidly, and fibroids often shrink. *Nulliparous women* - Nulliparous women can have fibroids and experience various forms of degeneration, but **red degeneration** specifically is rare outside of pregnancy. - Degeneration in nulliparous women is more commonly **hyaline** or **cystic** degeneration.
Question 42: Which of the following statements about radical hysterectomy in stage Ib cervical cancer compared to radiotherapy is false?
- A. Chance of recurrence is lower with radical hysterectomy.
- B. Ovarian function can be preserved.
- C. Chance of survival is higher with radical hysterectomy.
- D. It is less complicated than radiotherapy. (Correct Answer)
Explanation: ***It is less complicated than radiotherapy.*** - Radical hysterectomy is a **major surgical procedure** with potential complications like **hemorrhage**, infection, **ureteral injury**, and **lymphedema**, which can be significant and life-altering. - Radiotherapy, while having its own set of side effects (e.g., **vaginal stenosis**, bladder/rectal irritation), typically avoids the acute surgical risks and recovery period associated with extensive surgery. *Chance of recurrence is lower with radical hysterectomy.* - For early-stage cervical cancer (Ib1/Ib2), both **radical hysterectomy** and **radiotherapy** provide **comparable outcomes** in terms of recurrence rates. - The choice between therapies often depends on patient factors, surgeon expertise, and pathological findings, but neither consistently demonstrates a significantly lower recurrence rate over the other in large cohorts. *Ovarian function can be preserved.* - In younger patients undergoing **radical hysterectomy**, it is often possible to **preserve the ovaries** by transplanting them or avoiding their removal if not directly involved, thus maintaining **endocrine function**. - **Pelvic radiotherapy**, in contrast, invariably leads to **ovarian radiation** and subsequent **ovarian failure** and menopause. *Chance of survival is higher with radical hysterectomy.* - For early-stage cervical cancer (Ib), **overall survival rates** are generally **equivalent** between radical hysterectomy and primary radiotherapy. - Meta-analyses and large retrospective studies have shown **similar 5-year survival rates** for both treatment modalities when applied appropriately to well-selected patients.
Question 43: A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?
- A. Stage 1C
- B. Stage 3C (Correct Answer)
- C. Stage 2C
- D. Stage 4C
Explanation: ***Stage 3C*** - **Bilateral ovarian carcinoma** with **capsule involvement**, **ascites**, and especially **paraaortic lymph node metastases** are defining features of Stage IIIC ovarian cancer. - Involvement of **retroperitoneal lymph nodes**, including paraaortic nodes, automatically upstages the disease to Stage III, irrespective of other abdominal spread. *Stage 1C* - This stage refers to ovarian cancer confined to **one or both ovaries**, with evidence of rupture, capsule involvement, or malignant cells in ascites/peritoneal washings, but **without lymph node involvement**. - The presence of **paraaortic lymphadenopathy** in this patient immediately excludes Stage 1C. *Stage 2C* - Stage 2 ovarian cancer involves one or both ovaries with **pelvic extension** beyond the ovaries, but still **without lymph node involvement**. - The patient's involvement of **paraaortic lymph nodes** goes beyond pelvic extension and therefore excludes Stage 2C. *Stage 4C* - Stage 4 ovarian carcinoma involves **distant metastasis** beyond the peritoneal cavity or distant lymph nodes (e.g., pleural effusion with positive cytology, parenchymal liver/spleen metastasis). - While paraaortic lymphadenopathy indicates advanced disease, it falls within the criteria for Stage 3 due to its location, not Stage 4.
Question 44: Most common presentation of cervical cancer is -
- A. Abnormal vaginal bleeding (Correct Answer)
- B. Pelvic pain
- C. Pain during intercourse
- D. Unusual vaginal discharge
Explanation: ***Abnormal vaginal bleeding*** - **Abnormal vaginal bleeding** is the most frequent presenting symptom of cervical cancer, often manifesting as **postcoital bleeding**, intermenstrual bleeding, or heavier, longer menstrual periods. - This symptom arises as the tumor on the cervix ulcerates and bleeds due to its friable nature and rich vascularization. *Pelvic pain* - **Pelvic pain** is typically a symptom of more **advanced cervical cancer**, indicating tumor invasion into surrounding tissues or nerves. - It is not usually an early or the most common presenting symptom, unlike abnormal bleeding. *Pain during intercourse* - **Pain during intercourse (dyspareunia)** can be a symptom of cervical cancer, particularly with larger lesions or those causing inflammation. - However, it is less common than abnormal bleeding and often occurs concurrently with or after the onset of bleeding symptoms. *Unusual vaginal discharge* - An **unusual vaginal discharge**, which may be watery, foul-smelling, or blood-tinged, can occur with cervical cancer. - While a common symptom, it is generally considered less frequent than abnormal vaginal bleeding as the primary presenting complaint.
Question 45: What is the first-line treatment for simple hyperplasia of the endometrium?
- A. Endometrial ablation (surgical procedure)
- B. Estrogen therapy (e.g., Estradiol)
- C. Total abdominal hysterectomy (surgical removal of the uterus)
- D. Progestin therapy (e.g., Medroxyprogesterone acetate) (Correct Answer)
Explanation: ***Progestin therapy (e.g., Medroxyprogesterone acetate)*** - **Progestin therapy** is the first-line treatment for simple endometrial hyperplasia because it counteracts the unopposed estrogen effect causing the hyperplasia. - **Progestins** lead to endometrial atrophy and shedding, helping to reverse the hyperplastic changes and prevent progression to cancer. *Estrogen therapy (e.g., Estradiol)* - **Estrogen therapy** without concomitant progestins would exacerbate endometrial hyperplasia by further stimulating endometrial growth. - This treatment is contraindicated in cases of endometrial hyperplasia unless carefully balanced with progestins. *Endometrial ablation (surgical procedure)* - **Endometrial ablation** is a destructive procedure to remove the endometrial lining and is typically considered for persistent abnormal uterine bleeding, not as a primary treatment for simple hyperplasia. - It is often reserved for patients who have completed childbearing and fail medical management. *Total abdominal hysterectomy (surgical removal of the uterus)* - A **total abdominal hysterectomy** is an invasive surgical procedure that is generally reserved for complex or atypical endometrial hyperplasia, or hyperplasia that is recurrent and unresponsive to medical management. - It is not the first-line treatment for simple hyperplasia, especially in patients who may desire future fertility or wish to avoid major surgery.
Question 46: What is the most common presenting feature of a complete mole?
- A. Vomiting
- B. Hyperemesis gravidarum
- C. Amenorrhoea
- D. Bleeding per vaginum (Correct Answer)
Explanation: ***Bleeding per vaginum (Correct)*** - **Vaginal bleeding** in the first or early second trimester is the **most common presenting symptom** of a complete hydatidiform mole, occurring in approximately 80-90% of cases - This bleeding can vary in amount and color, often described as **prune juice-like** discharge with passage of grape-like vesicles in some cases - Typically presents between **6-16 weeks of gestation** as the most frequent initial clinical sign *Vomiting (Incorrect)* - While nausea and vomiting are common in normal pregnancies, this is **not the most common presenting feature** of a complete mole - Vomiting may occur but is less specific and typically occurs after or in conjunction with vaginal bleeding - When severe, it manifests as hyperemesis gravidarum (a separate entity) *Hyperemesis gravidarum (Incorrect)* - This condition, characterized by **severe, persistent nausea and vomiting**, is more prevalent in molar pregnancies due to **excessively high hCG levels** - Occurs in approximately **25-30% of complete moles**, making it a significant but not the most common presentation - It is a **consequence** of the molar pregnancy, often presenting **after** initial bleeding, and is not the most frequent first clinical sign *Amenorrhoea (Incorrect)* - **Amenorrhoea** (absence of menstruation) is a **universal symptom** of any pregnancy, including a molar pregnancy - While it indicates conception, it does **not differentiate** a molar pregnancy from a normal pregnancy or other causes of amenorrhoea - Therefore, it is not the most specific or common **presenting feature** that would lead to diagnosis of a molar pregnancy
Question 47: Which condition is characterized by androgenesis (purely paternal genetic origin)?
- A. Androgenic complete mole (Correct Answer)
- B. Turner's syndrome
- C. Polycystic ovary syndrome (PCOS)
- D. Androgenic partial mole
Explanation: ***Androgenic complete mole*** - A **complete hydatidiform mole** is characterized by the absence of maternal genetic material and a **purely paternal genetic origin** (androgenesis). - This typically results from the **fertilization of an 'empty' egg** by either two haploid sperm or one diploid sperm. *Turner's syndrome* - This condition is a **chromosomal disorder** in females where one of the two X chromosomes is missing or incomplete (45, X0). - It is not associated with androgenesis but rather with the **absence of a functionally complete X chromosome**. *Polycystic ovary syndrome (PCOS)* - PCOS is an **endocrine disorder** characterized by **hormonal imbalance** (high androgens), ovulatory dysfunction, and polycystic ovaries. - It involves maternal and paternal genetic contributions in a normal diploid set and is not related to androgenesis. *Androgenic partial mole* - A **partial hydatidiform mole** typically involves **triploidy**, where there are two sets of paternal chromosomes and one set of maternal chromosomes (e.g., 69, XXX or 69, XXY). - While it involves extra paternal genetic material, it is not purely paternal in origin, as a **maternal haploid set is also present**.
Question 48: In which part of the fallopian tube is there a high chance of rupture in a tubal pregnancy?
- A. Interstitial
- B. Fimbrial
- C. Isthmus (Correct Answer)
- D. Ampulla
Explanation: ***Isthmus*** - The **isthmus** is the narrowest and most muscular part of the fallopian tube. Due to its limited ability to stretch, an ectopic pregnancy here is highly prone to rupture **earlier** than in other segments (typically 6-8 weeks). - The **isthmic portion's** small lumen and thick muscular wall make rupture a rapid and common complication, often before significant fetal growth, giving it the **highest chance of rupture** when an ectopic pregnancy implants there. *Ampulla* - The **ampulla** is the most common site for ectopic pregnancies (approximately 70%) due to its wider lumen and being the usual site of fertilization. - However, rupture in the ampulla tends to occur **later** than in the isthmus (8-12 weeks) as it can accommodate the growing embryo for a longer period due to its greater distensibility. - While more ectopic pregnancies occur here in absolute numbers, each individual ampullary pregnancy has a **lower chance of rupture** compared to isthmic pregnancies. *Interstitial* - The **interstitial** (or cornual) part is the segment within the uterine wall, making it a rare site for ectopic pregnancies (2-4%). - Ruptures in the interstitial portion occur **latest** (12-16 weeks) but are often the most dangerous, leading to severe hemorrhage due to the surrounding vascularity of the uterus and proximity to uterine and ovarian arteries. *Fimbrial* - The **fimbrial** end is the portion closest to the ovary and is exceedingly rare for ectopic implantation. - Implantation near the fimbriae usually leads to an **"abdominal pregnancy"** if the embryo is extruded, or could result in early "tubal abortion" rather than a true rupture.
Question 49: Most common site of ectopic pregnancy is -
- A. Cervical
- B. Tubal (Correct Answer)
- C. Abdominal
- D. Ovarian
Explanation: ***Tubal*** - The **fallopian tubes** are the most common site for ectopic pregnancies, accounting for over **95%** of all cases. - This is because the fertilized ovum typically implants in the tube rather than reaching the uterus. *Abdominal* - **Abdominal ectopic pregnancies** are rare, occurring when the fertilized egg implants in the abdominal cavity. - They account for about **1%** of all ectopic pregnancies and often result in significant maternal complications. *Ovarian* - **Ovarian ectopic pregnancies** are very rare, occurring when the ovum is fertilized within the ovary itself. - They represent less than **1%** of all ectopic cases and can be difficult to diagnose. *Cervical* - **Cervical ectopic pregnancies** involve implantation within the cervical canal. - These are also very rare (less than **1%** of ectopic pregnancies) and are associated with a high risk of severe hemorrhage.
Question 50: What percentage of ectopic pregnancies occur in the fallopian tube?
- A. 90% (Correct Answer)
- B. 75%
- C. 80%
- D. 67%
Explanation: ***90%*** - Approximately **90-95%** of all ectopic pregnancies occur within the fallopian tube, making it the most common site. - The **ampulla** is the most frequent tubal site, accounting for about 80% of tubal ectopics, followed by the isthmus and fimbrial end. *75%* - While a significant percentage, **75%** falls short of the actual prevalence of tubal ectopic pregnancies. - This percentage does not accurately reflect the high frequency of implantation within the fallopian tube. *80%* - **80%** is a common statistic for ectopic pregnancies occurring in the **ampulla** specifically, which is a segment of the fallopian tube. - However, the overall percentage for all fallopian tube locations is higher than 80%. *67%* - **67%** is too low and does not represent the vast majority of ectopic pregnancies that are found within the fallopian tube. - Such a low percentage would imply a higher incidence of ectopic pregnancies in other locations (e.g., ovary, cervix, abdomen), which is not the case.