In which part of the fallopian tube is ectopic pregnancy most likely to survive longer?
Most common antigen involved in erythroblastosis fetalis is:
What is the primary hormonal cause of hot flushes experienced during menopause?
Poor prognostic factor for hydatidiform mole is -
Which of the following drugs is commonly used in the treatment of endometriosis?
Most common cause of secondary PPH is :
What is the recommended management for a patient with complete placenta previa at 38 weeks gestation without any vaginal bleeding?
Which of the following statements about nabothian cysts is true?
What is the most common cause of pelvic inflammatory disease?
Which of the following is the PRIMARY risk factor for cervical carcinoma?
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 21: In which part of the fallopian tube is ectopic pregnancy most likely to survive longer?
- A. Isthmus
- B. Ampulla
- C. Cornua
- D. Interstitial (Correct Answer)
Explanation: ***Interstitial*** - An **interstitial (intramural) pregnancy** occurs in the portion of the fallopian tube that passes through the muscular wall of the uterus, known as the **cornua**. This position allows for a larger and more distensible space, potentially accommodating the pregnancy for a longer duration before rupture. - The surrounding **myometrial tissue** can provide a temporary blood supply and structural support, leading to later presentation (often up to 12-16 weeks) and often more significant hemorrhage upon rupture due to the rich vascularization of the uterine wall. - Interstitial pregnancies account for approximately 2-4% of all ectopic pregnancies but have a higher mortality rate due to massive hemorrhage when rupture occurs. *Isthmus* - The **isthmus** is the narrowest part of the fallopian tube, making it less accommodating for an ectopic pregnancy. - Pregnancies here tend to rupture earlier (typically by 6-8 weeks) due to limited space and thinner muscular walls. - Accounts for approximately 12% of tubal ectopic pregnancies. *Ampulla* - The **ampulla** is the most common site for ectopic pregnancies (approximately 70-80%), but pregnancies here typically rupture earlier than interstitial ones (usually by 8-12 weeks). - While wider than the isthmus, it lacks the substantial myometrial support of the interstitial portion. - The ampullary wall is thin and distensible but cannot sustain pregnancy as long as the interstitial portion. *Cornua* - While the interstitial part of the tube is located within the uterine wall (cornua), \"cornua\" itself refers to the upper angles of the uterus where the fallopian tubes enter. - The term **\"cornual pregnancy\"** is sometimes used interchangeably with **\"interstitial pregnancy,\"** though some authorities distinguish between them based on precise location. - Without the specific context of \"interstitial,\" this option is less precise in identifying the segment of the fallopian tube associated with prolonged survival.
Question 22: Most common antigen involved in erythroblastosis fetalis is:
- A. C antigen in Rh group
- B. E antigen in Rh group
- C. Duffy antigen
- D. D antigen in Rh group (Correct Answer)
Explanation: ***D antigen in Rh group*** - The **D antigen** is the most immunogenic of the Rh antigens and is responsible for the vast majority of cases of **erythroblastosis fetalis** (hemolytic disease of the fetus and newborn). - When an **Rh-negative mother** is exposed to Rh-positive fetal blood (usually during previous pregnancies or transfusions), she can form antibodies against the D antigen, which can then cross the placenta in subsequent pregnancies and attack Rh-positive fetal red blood cells. *C antigen in Rh group* - While the **C antigen** is part of the Rh blood group system, antibodies to it are much less common and typically cause less severe hemolytic disease compared to anti-D antibodies. - The C antigen is less immunogenic than the D antigen, meaning it is less likely to provoke an immune response in an Rh-negative individual. *E antigen in Rh group* - Similar to the C antigen, the **E antigen** is another Rh antigen, but antibodies against it (anti-E) are also less frequently implicated in severe erythroblastosis fetalis than anti-D. - Antibodies to E can cause hemolytic disease, but their clinical significance is usually milder than that of anti-D. *Duffy antigen* - The **Duffy antigen system** is separate from the Rh system and is known for its role in resistance to certain malarial parasites (e.g., *Plasmodium vivax*). - Although antibodies to Duffy antigens (anti-Fya, anti-Fyb) can cause **hemolytic disease of the fetus/newborn**, they are a far less common cause of erythroblastosis fetalis than antibodies to the Rh D antigen.
Question 23: What is the primary hormonal cause of hot flushes experienced during menopause?
- A. Increased noradrenaline with normal estrogen levels
- B. Increased noradrenaline
- C. Decreased estrogen levels (Correct Answer)
- D. Both increased noradrenaline and decreased estrogen levels
Explanation: ***Decreased estrogen levels*** - **Decreased estrogen** is the primary hormonal change during menopause, leading to thermoregulatory dysfunction in the hypothalamus. - This hormonal imbalance causes the **vasomotor symptoms** like hot flushes and night sweats. *Increased noradrenaline* - While **noradrenaline** (norepinephrine) is involved in thermoregulation, its increase is a **secondary event** triggered by the initial estrogen deficiency, not the primary cause. - Increased noradrenaline can exacerbate the **vasodilation** and heat dissipation experienced during a hot flush. *Increased noradrenaline with normal estrogen levels* - This option is incorrect because hot flushes are characteristic of menopause, which is defined by **decreased estrogen levels**. - **Normal estrogen levels** would typically prevent the severe thermoregulatory instability that causes hot flushes. *Both increased noradrenaline and decreased estrogen levels* - Although both factors are involved, the question asks for the **primary hormonal cause**. **Decreased estrogen** initiates the cascade of events, including the subsequent alteration of neurotransmitter levels like noradrenaline. - Noradrenaline's role is more of a **mediator** in the physiological response to the primary estrogen deficiency.
Question 24: Poor prognostic factor for hydatidiform mole is -
- A. Prior molar pregnancy
- B. Metastasis to lung
- C. No prior chemotherapy
- D. WHO score > 8 (Correct Answer)
Explanation: ***WHO score > 8*** - A **WHO score > 8** (more specifically, WHO/FIGO score ≥7) indicates **high-risk gestational trophoblastic neoplasia (GTN)**, which is associated with a poor prognosis and requires multi-agent chemotherapy. - The WHO prognostic scoring system incorporates various factors: age, prior pregnancy outcome, antecedent pregnancy type, interval from index pregnancy, pre-treatment hCG level, largest tumor size, site of metastases, and number of metastases. - This is the **strongest poor prognostic indicator** among the options listed. *Prior molar pregnancy* - A **prior molar pregnancy** increases the *risk* of developing another molar pregnancy (recurrence risk ~1-2%), but it is **not a component of the WHO prognostic scoring system** and is not a poor prognostic factor for the outcome of current GTN. - The history affects surveillance requirements but doesn't dictate the difficulty of treating the current episode. *Metastasis to lung* - **Lung metastases** are actually among the **better prognostic sites** for metastatic GTN in the WHO scoring system. - Lung and vaginal metastases score only 1 point, whereas liver and brain metastases (true poor prognostic sites) score 4 points each. - While any metastasis indicates more advanced disease, isolated lung metastases generally have a *good prognosis* with appropriate chemotherapy, with cure rates >90%. *No prior chemotherapy* - The *absence* of **prior chemotherapy** is a **favorable prognostic factor**, not a poor one. - Patients who have *failed* prior chemotherapy or have received ≥2 drugs previously score 2-4 points in the WHO system, indicating worse prognosis. - No prior chemotherapy (scores 0 points) means better treatment response and outcomes.
Question 25: Which of the following drugs is commonly used in the treatment of endometriosis?
- A. None of the above
- B. Letrozole
- C. Mifepristone
- D. Combined oral contraceptives (Correct Answer)
Explanation: ***Combined oral contraceptives*** - **Combined oral contraceptives (COCs)** are the **most commonly used first-line medical treatment** for endometriosis, as they suppress ovulation and reduce estrogen production, thereby reducing endometrial lesion growth. - They help manage **endometriosis-associated pain** by decreasing menstrual flow and uterine contractions. - COCs are widely prescribed due to their efficacy, safety profile, and additional contraceptive benefits. *Letrozole* - **Letrozole** is an aromatase inhibitor that reduces local estrogen production and has shown efficacy in treating endometriosis, particularly in refractory cases. - However, it is **not commonly used as first-line therapy** due to potential side effects (bone density concerns, teratogenicity) and is typically reserved for cases resistant to conventional hormonal therapy. - It may be used in combination with progestins for better outcomes. *Mifepristone* - **Mifepristone** is an antiprogestin primarily used for medical abortion or in the treatment of Cushing's syndrome. - It works by blocking **progesterone receptors** and is not a standard treatment for endometriosis. *None of the above* - This option is incorrect because **combined oral contraceptives** are the most widely accepted and commonly used treatment for endometriosis.
Question 26: Most common cause of secondary PPH is :
- A. Retained placenta (Correct Answer)
- B. Cervical tear
- C. Uterine atony
- D. Vaginal laceration
Explanation: ***Retained placenta*** - Retained placental tissue prevents the uterus from contracting effectively, leading to continued bleeding after delivery. - While it's a common cause of primary PPH as well, it often presents as a secondary PPH when small fragments remain and later detach or become infected. *Uterine atony* - This is the **most common cause of primary PPH**, occurring within 24 hours of delivery due to the uterus failing to contract. - It is less likely to be the primary cause of secondary PPH unless there's a delayed presentation. *Vaginal laceration* - Lacerations of the vagina usually present as **primary PPH**, with bright red blood despite a well-contracted uterus. - While bleeding can persist, it's not the most common cause of delayed, secondary PPH. *Cervical tear* - Cervical tears also typically cause **primary PPH**, characterized by continuous bleeding immediately after delivery. - Similar to vaginal lacerations, while continuous bleeding can occur, it's not the most common etiology for secondary PPH.
Question 27: What is the recommended management for a patient with complete placenta previa at 38 weeks gestation without any vaginal bleeding?
- A. Elective caesarean section (Correct Answer)
- B. Observation and monitoring until delivery
- C. Conservative management with bed rest
- D. Urgent caesarean section due to bleeding risk
Explanation: ***Elective caesarean section*** - For women with **complete placenta previa** at term (38 weeks), an **elective caesarean section** is the recommended mode of delivery to avoid significant hemorrhage. - Even in the absence of bleeding, the risk of massive hemorrhage during labor with a complete previa is high, necessitating planned surgical delivery. *Observation and monitoring until delivery* - This approach is not safe for complete placenta previa at term due to the high risk of **unpredictable, severe hemorrhage** once labor begins or the cervix dilates. - Active monitoring without planned intervention carries significant maternal and fetal risk. *Conservative management with bed rest* - While bed rest may be used in cases of **placenta previa with bleeding** earlier in gestation to prolong pregnancy, it does not address the fundamental risk of hemorrhage from a complete previa at 38 weeks. - It would not prevent the need for an eventual caesarean section and prolongs potential risks. *Urgent caesarean section due to bleeding risk* - While there is a bleeding risk, this scenario describes a patient at 38 weeks gestation **without any vaginal bleeding**, making it an elective, rather than urgent, situation. - An **urgent caesarean section** is typically reserved for cases where active bleeding or other obstetric emergencies are present.
Question 28: Which of the following statements about nabothian cysts is true?
- A. It is a premalignant condition that requires excision.
- B. It is a malignant condition.
- C. Squamous epithelium grows over columnar epithelium, blocking mucus-secreting glands. (Correct Answer)
- D. It may be associated with chronic irritation and inflammation but is not defined by it.
Explanation: ***Squamous epithelium grows over columnar epithelium, blocking mucus-secreting glands.*** - **Nabothian cysts** form when the **squamous epithelium** of the ectocervix grows over the **columnar epithelium** of the endocervix during the process of **squamous metaplasia**. - This epithelial overgrowth obstructs the ducts of the **mucus-secreting endocervical glands**, leading to mucus retention and cyst formation. - This is the **classic pathophysiological mechanism** and the defining feature of nabothian cyst formation. *It is a premalignant condition that requires excision.* - **Nabothian cysts are completely benign** and have **no malignant or premalignant potential**. - They are **incidental findings** that require **no treatment** and can be safely observed. - Misclassifying them as premalignant would lead to unnecessary surgical interventions. *It is a malignant condition.* - **Nabothian cysts** are universally considered **benign retention cysts** with no malignant characteristics. - They are among the most common benign findings on cervical examination. *It may be associated with chronic irritation and inflammation but is not defined by it.* - While **chronic cervicitis** can be a predisposing factor for squamous metaplasia (which leads to nabothian cysts), this statement is **too vague** to be the best answer. - The **defining characteristic** of a nabothian cyst is the **anatomical mechanism** (squamous epithelium blocking glandular ducts), not the associated inflammatory conditions.
Question 29: What is the most common cause of pelvic inflammatory disease?
- A. Chlamydia and gonorrhea infections (Correct Answer)
- B. Pelvic peritonitis
- C. Puerperal sepsis
- D. Intrauterine Contraceptive Device (IUCD)
Explanation: ***Correct: Chlamydia and gonorrhea infections*** - **Chlamydia trachomatis** and **Neisseria gonorrhoeae** are the most frequently identified bacterial causes of PID, accounting for the majority of cases. - These infections often begin as **asymptomatic cervical infections** that ascend to the upper genital tract (uterus, fallopian tubes, ovaries). - They cause inflammation and scarring of the fallopian tubes and surrounding pelvic structures, forming the pathological basis of PID. - Early detection and treatment are crucial to prevent long-term complications like infertility and chronic pelvic pain. *Incorrect: Pelvic peritonitis* - **Pelvic peritonitis** is an inflammation of the peritoneum within the pelvis, which is a **complication** of severe PID, not the primary cause. - It represents a more advanced stage of infection where inflammation has spread beyond the reproductive organs to the peritoneal cavity. - While it involves pelvic inflammation, its origin typically stems from untreated bacterial infections like Chlamydia or gonorrhea. *Incorrect: Puerperal sepsis* - **Puerperal sepsis** is an infection of the genital tract occurring specifically after **childbirth, miscarriage, or abortion**. - While it involves pelvic infection, it is a distinct clinical entity related to the **postpartum or post-abortion period**. - PID, in contrast, typically occurs in sexually active women of reproductive age, unrelated to pregnancy outcomes. *Incorrect: Intrauterine Contraceptive Device (IUCD)* - An **IUCD** is an **independent risk factor** for PID, particularly in the first 3 weeks after insertion. - The IUCD itself does not directly cause PID; rather, it may facilitate the entry and ascent of pre-existing cervical infections. - The increased risk is primarily during insertion when bacteria can be introduced into the uterine cavity. - Modern IUCDs have lower PID risk, and the benefit-risk ratio favors their use in appropriate candidates.
Question 30: Which of the following is the PRIMARY risk factor for cervical carcinoma?
- A. Human papilloma virus (Correct Answer)
- B. Smoking
- C. Low socioeconomic status
- D. All of the options
Explanation: ***Human papilloma virus*** - **High-risk HPV types**, particularly **HPV 16 and 18**, are the primary causative agent of cervical carcinoma, responsible for over 90% of cases. - HPV infection is the **most significant and essential risk factor**, leading to persistent changes in cervical cells that can progress to **dysplasia** and eventually **invasive cancer**. - Cervical cancer is considered an **HPV-associated malignancy**, making HPV the central etiological factor. *Smoking* - **Smoking** is an important cofactor that increases the risk of cervical carcinoma in women with HPV infection, but it is not the primary cause. - Smoking impairs the immune system's ability to clear HPV infections and promotes progression of HPV-induced lesions. - Without HPV infection, smoking alone does not cause cervical cancer. *Low socioeconomic status* - **Low socioeconomic status** is an indirect risk factor associated with reduced access to healthcare and **cervical cancer screening** (Pap smears). - It does not directly cause cervical cancer but leads to delayed diagnosis and treatment, resulting in poorer outcomes. *All of the options* - While all listed factors influence cervical carcinoma risk, **Human papillomavirus (HPV)** is the primary and essential causative agent. - The other factors are cofactors or indirect associations, not primary causes.