Bishop scoring is done for ?
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?
Which organism causes puerperal sepsis?
The 'T' sign is associated with which condition?
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?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 71: Bishop scoring is done for ?
- A. Exchange transfusion in newborns
- B. Newborn ventilation assessment
- C. Newborn gestation assessment
- D. Induction of labor assessment (Correct Answer)
Explanation: ***Induction of labor assessment*** - The **Bishop score** is a pre-labor scoring system used to assess the ripeness of the cervix. - A higher score indicates a more **favorable cervix** for the successful **induction of labor**. *Exchange transfusion in newborns* - **Exchange transfusion** is primarily indicated for severe hyperbilirubinemia or hemolytic disease in newborns. - Its assessment is based on **bilirubin levels** and other clinical factors, not the Bishop score. *Newborn ventilation assessment* - **Newborn ventilation assessment** involves evaluating respiratory effort, heart rate, and oxygenation status, often using scores like the **Apgar score**. - The Bishop score is unrelated to neonatal respiratory function. *Newborn gestation assessment* - **Newborn gestation assessment** is typically performed using methods like the **New Ballard Score** or by reviewing prenatal ultrasound dating. - The Bishop score is used in *maternal* obstetric management, not directly for neonatal gestational age estimation.
Question 72: 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 73: 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 74: 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 75: 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 76: 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 77: 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 78: 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 79: 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 80: 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.