In Stein-Leventhal syndrome, which hormone is raised?
Which of the following actions should be avoided during the delivery of an Rh-negative mother?
What is the most likely cause of yellow-green watery discharge and pruritus in a female patient?
Which of the following is the most common genital infection in pregnancy?
Which drug is associated with decreased fetal heart rate during labor?
What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?
A young sexually active female presents with intense pruritus and watery discharge. What is the most likely causative organism?
The 'T' sign is associated with which condition?
Which organism causes puerperal sepsis?
All are true about constriction rings except which of the following?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 61: 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 62: 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**.
Question 63: What is the most likely cause of yellow-green watery discharge and pruritus in a female patient?
- A. Candida
- B. Bacterial vaginosis
- C. Chlamydia trachomatis
- D. Trichomonas vaginalis (Correct Answer)
Explanation: ***Trichomonas vaginalis (Correct)*** - The characteristic presentation of **yellow-green, frothy, watery vaginal discharge** with associated **pruritus** is highly suggestive of **trichomoniasis**. - Other clinical findings may include **dyspareunia**, **dysuria**, and a **"strawberry cervix"** on speculum examination. - Trichomoniasis is a sexually transmitted infection caused by the protozoan *Trichomonas vaginalis*. *Candida (Incorrect)* - **Candidiasis** (yeast infection) typically presents with **thick, white, cottage cheese-like discharge** and severe pruritus, often described as a burning sensation. - The discharge is usually not watery or yellow-green, and the characteristic fishy odor is absent. - pH is typically normal (<4.5), unlike trichomoniasis where pH is elevated (>4.5). *Bacterial vaginosis (Incorrect)* - **Bacterial vaginosis** is characterized by a **thin, gray-white discharge** with a **fishy odor**, especially after intercourse or with alkalinization. - The discharge is not typically yellow-green or frothy. - Pruritus may be present but is usually less prominent than with candidiasis or trichomoniasis. *Chlamydia trachomatis (Incorrect)* - **Chlamydia** infection is often **asymptomatic** in women (up to 70% of cases), but when symptoms occur, they may include **mucopurulent cervical discharge**, intermenstrial bleeding, or lower abdominal pain. - It does not typically cause the **profuse, frothy, yellow-green discharge** with significant pruritus described in this clinical presentation. - Chlamydia primarily causes cervicitis rather than vaginitis.
Question 64: Which of the following is the most common genital infection in pregnancy?
- A. Vaginal candidiasis (Correct Answer)
- B. Gonorrhea
- C. Chlamydia
- D. Bacterial vaginosis
Explanation: ***Vaginal candidiasis*** - **Vaginal candidiasis**, commonly known as a yeast infection, is the **most frequent genital infection** during pregnancy due to hormonal changes that alter the vaginal microenvironment. - Pregnancy increases susceptibility through **elevated estrogen levels**, **increased vaginal glycogen**, and **altered vaginal pH**. - While generally not harmful to the fetus, it can cause significant maternal discomfort with symptoms like **itching**, burning, and a **thick, white, cottage cheese-like discharge**. *Gonorrhea* - Gonorrhea is a **sexually transmitted infection (STI)** that, although possible, is not the most common genital infection in pregnancy. - It carries a risk of serious complications for both mother and infant, including **preterm birth**, **chorioamnionitis**, and **neonatal conjunctivitis** (ophthalmia neonatorum). *Chlamydia* - Chlamydia is another **STI** that can occur during pregnancy but is not as common as candidiasis. - Untreated chlamydia can lead to **preterm rupture of membranes**, **preterm labor**, and **postpartum endometritis** in the mother, and **conjunctivitis** or **pneumonia** in the newborn. *Bacterial vaginosis* - Bacterial vaginosis (BV) is a common vaginal infection caused by an **imbalance in normal vaginal flora**, with overgrowth of anaerobic bacteria. - While BV is the most common vaginal infection in **non-pregnant women**, vaginal candidiasis is more frequently encountered during pregnancy due to hormonal changes. - BV in pregnancy is associated with increased risk of **preterm birth**, **preterm rupture of membranes**, and **postpartum endometritis**, making screening and treatment important.
Question 65: Which drug is associated with decreased fetal heart rate during labor?
- A. Oxytocin (Correct Answer)
- B. Sodium bicarbonate
- C. IV fluids
- D. Iron
Explanation: ***Oxytocin*** - **Oxytocin** stimulates uterine contractions, which can reduce blood flow to the placenta and temporarily decrease **fetal oxygenation**, leading to **fetal heart rate decelerations**. - Overstimulation of the uterus by oxytocin can result in **tachysystole** (>5 contractions in 10 minutes), potentially causing **fetal hypoxia** and associated changes in fetal heart rate patterns such as late decelerations or bradycardia. *Sodium bicarbonate* - **Sodium bicarbonate** is used to correct metabolic acidosis, but it does not directly affect **fetal heart rate** or uterine activity in a way that causes decelerations. - Its administration is unlikely to impact fetal heart rate unless the underlying condition causing acidosis also affects fetal well-being, which is not a direct drug effect. *IV fluids* - **Intravenous fluids** are often administered during labor to maintain hydration and support maternal circulation, which generally helps improve **fetal well-being** and maintain normal fetal heart rate patterns. - They can help optimize **uterine perfusion**, thereby improving oxygen delivery to the fetus and reducing the risk of fetal distress. *Iron* - **Iron** is essential for red blood cell production and preventing maternal anemia; it has no direct or acute effect on **fetal heart rate** during labor. - Administered as a supplement, iron is not a medication used during labor to impact **uterine contractility** or fetal heart rate in the way oxytocin does.
Question 66: What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?
- A. 10mg
- B. 20mg
- C. 200mg (Correct Answer)
- D. 100mg
Explanation: ***200mg*** - The standard dose of **mifepristone** for medical termination of pregnancy (MTP) is **200mg orally**. - This dose is typically followed 24-48 hours later by a **prostaglandin analog** (e.g., misoprostol) to complete the termination process. *10mg* - This dose is significantly lower than the recommended therapeutic dose for medical abortion. - Such a low dose would likely be **ineffective** in achieving termination. *20 mg* - This dose is also much lower than the standard therapeutic recommendation. - It would not adequately block progesterone receptors to initiate the termination process effectively. *100mg* - While closer to the standard dose, 100mg is still considered **sub-therapeutic** for many individuals undergoing medical abortion. - A lower efficacy rate would be expected compared to the 200mg dose.
Question 67: A young sexually active female presents with intense pruritus and watery discharge. What is the most likely causative organism?
- A. Chlamydia trachomatis
- B. Candida albicans
- C. Gardnerella vaginalis
- D. Trichomonas vaginalis (Correct Answer)
Explanation: ***Trichomonas vaginalis*** - **Trichomoniasis** commonly presents with **intense vulvovaginal pruritus**, a **frothy, greenish-yellow discharge**, and sometimes a **strawberry cervix**. - It is a **sexually transmitted infection (STI)** caused by a flagellated protozoan. *Candida vaginitis* - Typically causes severe **pruritus**, **dysuria**, and a **thick, white, curd-like discharge**, often without the watery characteristic. - Known as a **yeast infection**, it is caused by an overgrowth of *Candida* species. *Gardnerella vaginalis* - Associated with **bacterial vaginosis**, which presents with a **thin, grayish-white discharge** and a **fishy odor**, especially after intercourse, but usually less intense pruritus. - It's characterized by an imbalance of vaginal flora rather than being a true STI in the same sense as trichomoniasis. *Chlamydia trachomatis* - Often causes **asymptomatic infections** or symptoms such as **mucopurulent discharge**, **dysuria**, or **post-coital bleeding**, but usually **not intense pruritus** or watery discharge. - It is a **bacterial STI** known for causing cervicitis and pelvic inflammatory disease.
Question 68: The 'T' sign is associated with which condition?
- A. Dichorionic twin pregnancy
- B. Monochorionic twin pregnancy (Correct Answer)
- C. Normal singleton pregnancy
- D. Multiple gestation
Explanation: ***Monochorionic twin pregnancy*** - The **'T' sign** on ultrasound is highly suggestive of a **monochorionic twin pregnancy**, indicating shared placenta and a thin inter-twin membrane that meets the chorion at a sharp, T-shaped angle. - This sign identifies the absence of a chorionic plate extending into the inter-twin membrane, distinguishing it from thick-membraned dichorionic pregnancies. *Dichorionic twin pregnancy* - Dichorionic pregnancies typically exhibit the **'lambda' or 'twin peak' sign**, where the chorion extends into the inter-twin membrane, creating a triangular projection, not a 'T' shape. - This sign indicates two separate placentas (or fused but distinct placentas) and two chorions, leading to a thicker inter-twin membrane. *Normal singleton pregnancy* - A normal singleton pregnancy involves only one fetus, and therefore no inter-twin membrane or associated signs like the 'T' or 'lambda' sign are present. - The concept of chorionicity and amnionicity is specific to multiple gestations, particularly twin pregnancies. *Multiple gestation* - While a monochorionic twin pregnancy is a type of multiple gestation, the term "multiple gestation" is too broad and does not specifically identify the **'T' sign**. - Multiple gestation can be either monochorionic or dichorionic, and only monochorionic pregnancies are associated with the 'T' sign.
Question 69: Which organism causes puerperal sepsis?
- A. Group A beta hemolytic streptococci (Correct Answer)
- B. CMV
- C. Toxoplasma gondii
- D. Group B beta hemolytic streptococci
Explanation: ***Group A beta hemolytic streptococci*** - **Group A Streptococcus (GAS)**, specifically *Streptococcus pyogenes*, is the **classic and most important cause of puerperal sepsis** (puerperal fever). - Historically, GAS was responsible for devastating epidemics of puerperal fever in maternity wards before the introduction of antiseptic practices by Ignaz Semmelweis. - GAS causes severe, rapidly progressive postpartum infections with **high morbidity and mortality** if untreated. - Clinically presents with fever, severe uterine tenderness, and can progress to **toxic shock syndrome** and septicemia. *Group B beta hemolytic streptococci* - **Group B Streptococcus (GBS)**, *Streptococcus agalactiae*, can cause postpartum endometritis and maternal infections. - However, GBS is **more commonly associated with neonatal sepsis** rather than being the primary cause of classic puerperal sepsis. - While it can colonize the genital tract and cause infection, it is not the historical or most severe cause of puerperal fever. *CMV* - **Cytomegalovirus (CMV)** is a viral infection that causes congenital infections when transmitted in utero. - It is not a bacterial cause of **puerperal sepsis**, which is primarily a bacterial postpartum infection. *Toxoplasma gondii* - **Toxoplasma gondii** is a parasite causing toxoplasmosis, which can lead to congenital abnormalities. - It is not associated with **puerperal sepsis**, which is a bacterial infection of the postpartum period.
Question 70: All are true about constriction rings except which of the following?
- A. Can be caused by excessive use of oxytocin.
- B. Also known as Schroeder's ring. (Correct Answer)
- C. Ring can be palpated per abdomen
- D. Inhalation of amyl nitrate can relax the ring.
Explanation: ***Also known as Schroeder's ring.*** - This statement is **INCORRECT** and is the correct answer to this "except" question. - **Schroeder's ring** is NOT synonymous with constriction rings. Schroeder's ring is a **physiological retraction ring** at the junction of the upper and lower uterine segments, which is a normal finding. - **Constriction rings** are **pathological, localized spastic contractions** of the uterine muscle at any level, causing obstruction to fetal descent. They differ from Bandl's pathological retraction ring. *Can be caused by excessive use of oxytocin.* - **Excessive oxytocin** can lead to **uterine hyperstimulation** and **incoordinate uterine contractions**, which may result in the formation of constriction rings. - This is a known iatrogenic cause of pathological constriction rings during labor. *Ring can be palpated per abdomen* - **Constriction rings** can sometimes be palpated as a **depression or groove** on the uterine surface during abdominal examination when they are well-developed. - They present as localized areas of myometrial spasm that may be clinically detectable. *Inhalation of amyl nitrate can relax the ring.* - **Amyl nitrite** (or amyl nitrate) is a **smooth muscle relaxant** that can be used to relax uterine constriction rings. - It acts as a **vasodilator** and **uterine relaxant**, temporarily relieving the spastic contraction to facilitate delivery or manual manipulation.