What is the most common fetal complication associated with gestational diabetes?
What is the most common presenting symptom of TB endometritis?
What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?
Acute PID, the most common route of spread?
What is the primary maternal cause of fetal macrosomia (large birth weight) in newborns?
A patient presents with a history of vaginal prolapse and a painful ulcer on the prolapsed tissue. What is the most likely diagnosis?
Which condition is associated with HAIR-AN syndrome?
Which hormone is known to be elevated in Polycystic Ovary Syndrome (PCOS)?
In Stein-Leventhal syndrome, which hormone is raised?
Which of the following actions should be avoided during the delivery of an Rh-negative mother?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 51: What is the most common fetal complication associated with gestational diabetes?
- A. Only a small percentage of women with gestational diabetes develop overt diabetes.
- B. There is a risk of macrosomia in babies born to mothers with gestational diabetes. (Correct Answer)
- C. Gestational diabetes is usually diagnosed in the second or third trimester.
- D. Gestational diabetes can increase the risk of congenital malformations.
Explanation: ***There is a risk of macrosomia in babies born to mothers with gestational diabetes.*** - **Macrosomia** (birth weight >4000g or >90th percentile) is a common complication due to fetal exposure to high glucose levels, stimulating excessive growth. - Increased fetal insulin from maternal hyperglycemia promotes fat accumulation and growth, leading to **shoulder dystocia**, birth trauma, and increased risk of C-section. *Only a small percentage of women with gestational diabetes develop overt diabetes.* - A significant percentage, up to **50% of women** with gestational diabetes, will develop **type 2 diabetes** later in life, often within 5-10 years postpartum, making this statement incorrect. - This persistent risk highlights the importance of postpartum screening and lifestyle modifications for these women. *Gestational diabetes is usually diagnosed in the second or third trimester.* - While screening typically occurs between **24 and 28 weeks of gestation** (second trimester), this describes when it is diagnosed, not the *most common risk* associated with the condition itself. - Early screening may occur in the first trimester for high-risk individuals, but the general screening period is later in pregnancy. *Gestational diabetes can increase the risk of congenital malformations.* - **Congenital malformations** are primarily associated with **pre-existing diabetes** (type 1 or type 2 diabetes) in the mother during the **first trimester**, when organogenesis occurs. - Gestational diabetes, diagnosed later in pregnancy, primarily leads to complications related to **fetal growth** and metabolic issues, not structural malformations.
Question 52: What is the most common presenting symptom of TB endometritis?
- A. Amenorrhoea
- B. Vaginal discharge
- C. Abdominal pain
- D. Infertility (Correct Answer)
Explanation: ***Infertility*** - **Infertility** is the most common presenting symptom of **tuberculosis (TB) endometritis**, particularly secondary infertility. - The infection leads to inflammation and scarring of the endometrium and fallopian tubes, impairing implantation and ovum transport. *Abdominal pain* - While **abdominal pain** can occur in TB endometritis, it is typically a less frequent or prominent presenting symptom compared to infertility. - Pain often arises from pelvic inflammation or adhesions but is not the cardinal complaint that prompts diagnosis. *Amenorrhoea* - **Amenorrhea** (absence of menstruation) can be a symptom, especially in advanced cases where there is significant destruction of the endometrium. - It is, however, less common than infertility as the initial presenting symptom. *Vaginal discharge* - **Vaginal discharge** is an uncommon symptom of TB endometritis. - When present, it is often non-specific and not characteristic enough to suggest TB as the underlying cause.
Question 53: What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?
- A. Within 3 weeks (Correct Answer)
- B. Within 5 weeks
- C. Within 7 weeks
- D. Within 14 weeks
Explanation: **Correct Answer: Within 3 weeks** - The highest risk of **Pelvic Inflammatory Disease (PID)** after IUD insertion is typically observed in the **first 20 days (approximately 3 weeks)** post-insertion. - This elevated risk is mainly due to the potential introduction of **bacteria** from the vagina or cervix into the uterus during the insertion process. - Studies show that the risk of PID is **6-fold higher** in the first 20 days compared to later periods. *Incorrect: Within 5 weeks* - While PID can occur after 3 weeks, the **highest incidence** is concentrated in the earlier period (first 3 weeks). - The risk significantly **decreases after the initial weeks**, suggesting that the critical window for bacterial ascent is shorter. *Incorrect: Within 7 weeks* - By 7 weeks, the risk of developing PID attributable to IUD insertion becomes **negligible** compared to the general population. - Most infections that manifest beyond the initial month are usually due to **newly acquired sexually transmitted infections (STIs)**, not the insertion itself. *Incorrect: Within 14 weeks* - At 14 weeks, any PID development is generally **not linked to the IUD insertion event** but rather to other risk factors like new sexual partners or untreated STIs. - The immediate trauma and potential bacterial contamination from the insertion procedure have **long ceased to be the primary cause** of infection.
Question 54: Acute PID, the most common route of spread?
- A. Descending
- B. Ascending infection (Correct Answer)
- C. Lymphatics
- D. Hematogenous
Explanation: ***Ascending infection*** - **Pelvic Inflammatory Disease (PID)** most commonly occurs when microorganisms from the **lower genital tract (vagina, cervix)** ascend into the upper genital tract (uterus, fallopian tubes, ovaries). - This upward spread leads to infection and inflammation of the endometrium (endometritis), fallopian tubes (salpingitis), and ovaries (oophoritis). *Descending* - A descending route of infection implies spread from an organ superior to the pelvis, which is not the typical mechanism for acute PID. - While infections can sometimes spread from adjacent structures, direct downward spread from non-genital organs is rare for primary PID. *Lymphatics* - While lymphatic spread can occur in some infections, it is not the primary or most common route for the initial onset of acute PID. - Lymphatic spread is more commonly associated with chronic or severe infections, or specific types of pelvic infections like tuberculosis. *Hematogenous* - Hematogenous spread involves pathogens traveling through the bloodstream to reach the pelvic organs. - This route is less common for typical acute PID but can be seen in cases of systemic infections or specific sexually transmitted infections like tuberculosis.
Question 55: What is the primary maternal cause of fetal macrosomia (large birth weight) in newborns?
- A. Hyperglycemia (Correct Answer)
- B. Hyperinsulinemia
- C. Multiparity
- D. Post maturity
Explanation: ***Hyperglycemia*** - Maternal **hyperglycemia**, often due to **gestational diabetes**, leads to increased glucose transfer across the placenta to the fetus. - This excess glucose stimulates increased fetal insulin production, which acts as a growth hormone causing macrosomia. *Hyperinsulinemia* - While fetal **hyperinsulinemia** directly causes macrosomia by increasing fetal growth, it is a **consequence** of maternal hyperglycemia, not the primary cause itself. - Fetal insulin acts as an anabolic hormone, promoting fat and protein synthesis and overall growth. *Multiparity* - **Multiparity** (having given birth to multiple children) is generally associated with moderately higher birth weights, but it is not the primary cause of macrosomia. - The effect is far less significant and consistent than that of maternal hyperglycemia. *Post maturity* - **Post-term pregnancy** (post maturity) can sometimes be associated with a larger birth weight, but this is less common and less pronounced than macrosomia caused by hyperglycemia. - Fetal growth often slows or even declines in prolonged pregnancies due to placental insufficiency.
Question 56: A patient presents with a history of vaginal prolapse and a painful ulcer on the prolapsed tissue. What is the most likely diagnosis?
- A. Carcinoma
- B. Pressure erosion
- C. Syphilis
- D. Decubitus ulcer (Correct Answer)
Explanation: ***Decubitus ulcer*** - A **decubitus ulcer** (pressure sore) is the most likely diagnosis when a patient with a **vaginal prolapse** develops a **painful ulcer** on the prolapsed tissue due to chronic pressure and friction. - The prolapsed tissue is often exposed to constant irritation and lack of proper blood supply, making it susceptible to ulceration. *Carcinoma* - While possible, carcinoma typically presents as a **non-healing lesion** with irregular borders and induration, and is often *not immediately painful* in its early stages. - A definitive diagnosis of carcinoma requires **biopsy and histopathological examination**. *Pressure erosion* - This term is a general description of tissue damage from pressure and can be a precursor to a decubitus ulcer, but **decubitus ulcer** specifically denotes the developed lesion. - It describes the *mechanism of injury* rather than the specific, fully formed ulcer. *Syphilis* - Syphilis causes a **chancre**, which is typically a *painless ulcer* with indurated borders. - It is a sexually transmitted infection, and while it could cause an ulcer, the context of a **vaginal prolapse** points more strongly to a localized pressure injury.
Question 57: Which condition is associated with HAIR-AN syndrome?
- A. CA ovary
- B. Adrenal tumours
- C. Endometriosis
- D. Polycystic Ovary Syndrome (PCOS) (Correct Answer)
Explanation: ***Polycystic Ovary Syndrome (PCOS)*** - **HAIR-AN syndrome** is a specific, severe form of **PCOS**, characterized by **HyperAndrogenism**, **Insulin Resistance**, and severe **Acanthosis Nigricans**. - It represents the most pronounced metabolic and endocrine abnormalities associated with PCOS, often with significant hyperinsulinemia. *Endometriosis* - Endometriosis involves the growth of **endometrial-like tissue outside the uterus**, causing pain and infertility. - It is not directly linked to the metabolic and hormonal disturbances seen in HAIR-AN syndrome. *CA ovary* - **Ovarian cancer** is a malignant proliferation of ovarian cells, which is not associated with the unique features of **hyperandrogenism**, **insulin resistance**, or **acanthosis nigricans** that define HAIR-AN syndrome. - Ovarian tumors can be hormone-producing, but this is distinct from the syndrome's chronic metabolic dysregulation. *Adrenal tumours* - **Adrenal tumors** can cause **hyperandrogenism** in some cases, leading to symptoms like hirsutism, but they typically do not present with the constellation of **insulin resistance** and severe **acanthosis nigricans** that define HAIR-AN syndrome. - The primary defect in HAIR-AN is ovarian and metabolic, rather than adrenal.
Question 58: Which hormone is known to be elevated in Polycystic Ovary Syndrome (PCOS)?
- A. FSH
- B. Estrogen
- C. TSH
- D. Luteinizing Hormone (LH) (Correct Answer)
Explanation: ***Luteinizing Hormone (LH)*** - In **Polycystic Ovary Syndrome (PCOS)**, there is often an elevated **Luteinizing Hormone (LH)** level, leading to an increased **LH:FSH ratio**. - This high LH level contributes to **increased androgen production** by the ovaries, a key feature of PCOS. *FSH* - **Follicle-stimulating hormone (FSH)** levels are typically normal or even low in PCOS, contributing to the **imbalance with LH**. - This relative deficiency of FSH impairs proper **follicle maturation**, leading to anovulation and cyst formation. *Estrogen* - While **estrogen** levels can be normal or slightly elevated due to peripheral conversion of androgens, they are not primarily responsible for the characteristic hormonal imbalance in PCOS. - The elevated **androgens** in PCOS are converted to estrogen in adipose tissue, but this is a secondary effect. *TSH* - **Thyroid-stimulating hormone (TSH)** is involved in thyroid function and is generally unrelated to the **pathophysiology of PCOS**, although thyroid disorders can co-exist with PCOS. - Elevated TSH suggests **hypothyroidism**, a distinct endocrine condition that would present with different symptoms.
Question 59: In Stein-Leventhal syndrome, which hormone is raised?
- A. LH (Correct Answer)
- B. FSH
- C. GnRH
- D. Progesterone
Explanation: ***LH*** - In **Stein-Leventhal syndrome** (Polycystic Ovary Syndrome, PCOS), there is an elevated **LH (Luteinizing Hormone)** level. - This high LH-to-FSH ratio contributes to increased **androgen production** by the ovarian theca cells, leading to symptoms like hirsutism and anovulation. *FSH* - **FSH (Follicle-Stimulating Hormone)** levels are typically normal or even low in PCOS, contributing to the elevated LH:FSH ratio. - Low FSH levels impair proper follicle maturation, leading to **anovulation** and the characteristic polycystic appearance of the ovaries. *GnRH* - **GnRH (Gonadotropin-Releasing Hormone)** secretion can be altered in PCOS, often showing increased pulse frequency, which preferentially stimulates LH release over FSH. - However, **GnRH levels themselves are not directly measured** as "raised" in the clinical diagnostic criteria for PCOS. *Progesterone* - **Progesterone** levels are often low or absent in PCOS, particularly in the luteal phase, due to **anovulation**. - The lack of regular ovulation means no corpus luteum forms, which is responsible for progesterone production after ovulation.
Question 60: Which of the following actions should be avoided during the delivery of an Rh-negative mother?
- A. Gently perform manual removal of placenta if necessary (Correct Answer)
- B. Withhold ergometrine until after anterior shoulder delivery
- C. Administer IV fluids
- D. Apply fundal pressure during second stage of labor
Explanation: ***Gently perform manual removal of placenta if necessary*** - **Manual removal of the placenta** can significantly increase the risk of **fetomaternal hemorrhage**, which is particularly dangerous in an **Rh-negative mother**. Large amounts of fetal blood entering the maternal circulation can lead to significant alloimmunization, making subsequent pregnancies high-risk. - This procedure should be **avoided if possible** due to the heightened risk of sensitizing the mother to Rh antigens; if it is absolutely necessary, a **higher dose of Rh immunoglobulin** may be required. *Withhold ergometrine until after anterior shoulder delivery* - **Ergometrine** is a uterotonic agent used to prevent **postpartum hemorrhage**. Withholding it until after the birth of the anterior shoulder is a **standard practice** to prevent uterine tetany before the baby is fully delivered. - This action does not pose a specific risk to an **Rh-negative mother** related to Rh sensitization; it is a general obstetric safety measure to ensure safe delivery and should **not be avoided**. *Apply fundal pressure during second stage of labor* - **Fundal pressure** (applying pressure to the top of the uterus to expedite delivery) is a **controversial practice** that is generally discouraged due to potential maternal and fetal complications. - While it may theoretically carry a small risk of **fetomaternal hemorrhage**, it is not specifically contraindicated in Rh-negative mothers more than in others. The main concerns are **uterine rupture**, **maternal injury**, and **fetal trauma**. If appropriate precautions with **Rh immunoglobulin** are taken, Rh status alone is not a reason to avoid this practice (though it should generally be avoided for other safety reasons). *Administer IV fluids* - **Intravenous fluids** are commonly administered during labor and delivery to maintain **hydration**, support **blood pressure**, and provide a route for medications. This is a **routine and safe practice**. - Administering IV fluids has no direct impact on **Rh sensitization** and is not contraindicated in an **Rh-negative mother**.