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)?
At which gestational week does the maximum volume of amniotic fluid occur?
Rule of Hasse is used to determine:
Borax causes which of the following effects?
Uterine rupture is most common in -
Which nerve block is given in forceps delivery?
When should semen analysis be done?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 81: 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 82: 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 83: 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 84: At which gestational week does the maximum volume of amniotic fluid occur?
- A. 32 weeks
- B. 34 weeks
- C. 36 weeks (Correct Answer)
- D. 40 weeks
Explanation: ***36 weeks*** - The volume of **amniotic fluid** gradually increases during pregnancy, reaching its **peak** around **36 weeks** of gestation. - After 36 weeks, the volume of amniotic fluid typically begins to **decrease** as the pregnancy approaches term. *32 weeks* - At 32 weeks, the amniotic fluid volume is still **increasing** and has not yet reached its maximum level. - The fetus is actively growing and contributing to fluid production, but the peak is still several weeks away. *34 weeks* - Although significant, the amniotic fluid volume at 34 weeks has not yet reached its **maximum**. - The volume will continue to rise for another two weeks before plateauing and then declining. *40 weeks* - By 40 weeks, a normal-term pregnancy, the volume of amniotic fluid has typically **decreased** from its peak at 36 weeks. - A declining amniotic fluid volume (oligohydramnios) can be a concern at term if it's too low.
Question 85: Rule of Hasse is used to determine:
- A. Fetal age estimation (Correct Answer)
- B. Adult height measurement
- C. Determination of ethnicity
- D. General forensic identification
Explanation: ***Fetal age estimation*** - **Rule of Hasse** is specifically used for estimating the **fetal age** in forensic cases involving remains of an unborn fetus. - It relates the crown-heel length of the fetus in centimeters to its age in lunar months (first 5 lunar months) or halves of lunar months (second 5 lunar months). *Adult height measurement* - Adult height is typically measured directly or estimated using long bone lengths, an entirely different set of methods from Hasse's Rule. - This rule is specific to the **developing fetus** and not applicable to adults. *Determination of ethnicity* - Ethnicity determination involves analyzing skeletal features, particularly of the skull and pelvis, and is not related to fetal length or age estimation. - Hasse's Rule provides an age estimate based on size, not ancestral origin. *General forensic identification* - While forensic identification is a broad field, Hasse's Rule is a very specific tool for **fetal age assessment**, not general adult identification. - General forensic identification involves techniques like DNA analysis, fingerprinting, and skeletal remains analysis for adults.
Question 86: Borax causes which of the following effects?
- A. Induces uterine contractions (labor-inducing)
- B. Irritates genitourinary tract (side effect)
- C. Traditionally used to stimulate menstrual flow
- D. Causes gastrointestinal irritation (side effect) (Correct Answer)
Explanation: ***Causes gastrointestinal irritation (side effect)*** - Borax, specifically its component **boric acid**, is rapidly absorbed through the **gastrointestinal tract** and can cause symptoms like nausea, vomiting, and diarrhea even in small amounts. - This **gastrointestinal irritation** is a common sign of acute borax toxicity. *Induces uterine contractions (labor-inducing)* - While certain substances can induce uterine contractions, **borax is not known** or traditionally used for this purpose. - It is **not an oxytocic agent** and does not act on uterine smooth muscle in a way that would induce labor. *Irritates genitourinary tract (side effect)* - Although borax can be toxic, its primary route of significant irritation and toxicity is not typically the **genitourinary tract** in the way implied for adverse effects. - While it can be absorbed through mucous membranes, the genitourinary tract is not its primary target for **direct irritant effects** in systemic exposure. *Traditionally used to stimulate menstrual flow* - There is **no reliable scientific or traditional medical evidence** to support the use of borax to stimulate menstrual flow. - Substances used for this purpose, known as **emmenagogues**, are typically herbal or pharmaceutical preparations, and borax is **not among them**.
Question 87: Uterine rupture is most common in -
- A. Posterior lower segment
- B. Upper uterine segment
- C. Lateral uterine wall
- D. Anterior lower segment (Correct Answer)
Explanation: ***Anterior lower segment*** - The **anterior lower segment** is the most common site for **uterine rupture** due to prior **cesarean sections** or other uterine surgeries which are often performed anteriorly. - This area is thinner and more prone to stretching and tearing during labor, especially in cases of repeated surgical scars. *Posterior lower segment* - While rupture can occur in the **posterior lower segment**, it is less common than the anterior location. - This area is usually less stressed by previous surgical incisions compared to the anterior wall. *Upper uterine segment* - Rupture in the **upper uterine segment** typically involves an **unscarred uterus** and is a rare event, often associated with a **grand multiparous patient** or **oxytocin hyperstimulation**. - This type of rupture is usually spontaneous and more catastrophic due to the rich vascularity of the upper segment. *Lateral uterine wall* - Rupture of the **lateral uterine wall** is uncommon and usually associated with **trauma** or **manual extraction of the placenta**, rather than prior surgical scars. - It is not the most frequent site for spontaneous or scar-related uterine rupture.
Question 88: Which nerve block is given in forceps delivery?
- A. Posterior femoral
- B. Genitofemoral
- C. Ilioinguinal
- D. Pudendal (Correct Answer)
Explanation: ***Pudendal*** - A **pudendal block** anesthetizes the **perineum, vulva, and lower vagina**, providing pain relief for instrumental deliveries like **forceps delivery** and for episiotomy. - It involves injecting a local anesthetic near the **pudendal nerve** as it passes posterior to the **ischial spine**. *Posterior femoral* - The **posterior femoral cutaneous nerve** primarily innervates the skin of the posterior thigh and part of the perineum but does not provide sufficient deep analgesia for a forceps delivery. - Blocking this nerve alone would not adequately cover the extensive area affected during instrumental delivery. *Genitofemoral* - The **genitofemoral nerve** primarily innervates the skin of the upper medial thigh and parts of the genitalia but is not the primary nerve for pain relief during vaginal delivery procedures. - Its blockade would not provide the comprehensive analgesia needed for a forceps delivery. *Ilio inguinal* - The **ilioinguinal nerve** innervates the skin of the groin, mons pubis, and labia majora but does not provide sufficient anesthesia for the deeper structures involved in a forceps delivery. - An ilioinguinal nerve block is more commonly used for pain control in procedures involving the groin or hernia repair, not for instrumental vaginal delivery.
Question 89: When should semen analysis be done?
- A. After 30-60 mins irrespective of liquefaction
- B. As early as possible
- C. After liquefaction with thorough mixing (Correct Answer)
- D. After 15-30 mins irrespective of liquefaction
Explanation: ***After liquefaction with thorough mixing*** - Semen analysis should be performed **after complete liquefaction** (typically within 20-30 minutes, maximum 60 minutes) followed by **thorough mixing**. - According to **WHO guidelines (2010, 2021)**, the sample must first liquefy completely at room temperature, then be mixed well before microscopic examination. - This ensures accurate assessment of **sperm concentration, motility, and morphology** without artifacts from viscous semen. - The standard practice is to examine within **60 minutes of collection** but only after liquefaction is complete. *After 30-60 mins irrespective of liquefaction* - The phrase "irrespective of liquefaction" is **incorrect** as analysis before complete liquefaction leads to inaccurate results. - Performing analysis on a non-liquefied sample can cause **underestimation of sperm motility** and difficulty in proper microscopic assessment. - Liquefaction status must be assessed before proceeding with analysis. *As early as possible* - Analyzing too early before **liquefaction** (which typically takes 20-30 minutes) will yield inaccurate results. - A viscous, non-liquefied sample impairs proper **sperm movement assessment** and mixing. *After 15-30 mins irrespective of liquefaction* - While 30 minutes may be sufficient for many samples to liquefy, the phrase "irrespective of liquefaction" makes this incorrect. - Some samples may require up to **60 minutes** to liquefy completely, and analysis should not proceed until liquefaction is confirmed.