Menstrual Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Menstrual Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Menstrual Disorders Indian Medical PG Question 1: The following drugs are effective in the management of menorrhagia except :
- A. Progestational agents
- B. Prostaglandins (Correct Answer)
- C. Non-steroidal anti-inflammatory drugs
- D. Anti-fibrinolytic drugs
Menstrual Disorders Explanation: ***Prostaglandins***
- Prostaglandins, particularly **PGE2** and **PGF2α**, are generally associated with **increased uterine contractions** and **vasodilation**, which can worsen menstrual bleeding rather than reduce it.
- While cyclooxygenase inhibitors (NSAIDs) work by inhibiting prostaglandin synthesis, exogenous prostaglandins themselves are not used to treat menorrhagia and can exacerbate it.
*Progestational agents*
- Progestins help to **stabilize the endometrium**, reducing excessive bleeding by inducing decidualization and limiting endometrial growth.
- They can be administered orally, via injection, or through an **intrauterine device (IUD)** like the levonorgestrel-releasing IUD (Mirena), which is highly effective.
*Non-steroidal anti-inflammatory drugs*
- NSAIDs reduce menorrhagia by **inhibiting prostaglandin synthesis** in the endometrium, which leads to reduced vasodilation and uterine contractions.
- They also help alleviate associated **dysmenorrhea** (menstrual pain).
*Anti-fibrinolytic drugs*
- These drugs, such as **tranexamic acid**, work by **inhibiting plasminogen activation**, thereby preventing the breakdown of fibrin clots within the uterus.
- This promotes clot stability and reduces menstrual blood loss significantly.
Menstrual Disorders Indian Medical PG Question 2: In a population of 5000, there are 19 % eligible couples. To achieve a couple protection rate (CPR) of 60 %, how many of these should be covered for family planning services?
- A. 550
- B. 530
- C. 590
- D. 570 (Correct Answer)
Menstrual Disorders Explanation: ***570***
- First, calculate the total number of **eligible couples**: 19% of 5000 = (19/100) * 5000 = **950 couples**.
- To achieve a **Couple Protection Rate (CPR) of 60%**, calculate 60% of the eligible couples: 60% of 950 = (60/100) * 950 = **570 couples**.
*550*
- This option indicates a protection rate of approximately **57.9%** (550/950 * 100), which is less than the target of 60%.
- It does not meet the specified target for **Couple Protection Rate**.
*530*
- This option would result in a protection rate of approximately **55.8%** (530/950 * 100), which is significantly lower than the desired 60%.
- This value is an underestimation of the number of couples needed to achieve the target CPR.
*590*
- This option indicates a protection rate of approximately **62.1%** (590/950 * 100), which exceeds the target of 60%.
- While protecting more couples is generally good, the question asks for how many *should* be covered to achieve *60%* specifically, making 570 the exact answer.
Menstrual Disorders Indian Medical PG Question 3: The following hormonal changes mark the Polycystic Ovarian Disease except
- A. Raised LH, Low-to-normal FSH
- B. Hyperinsulinaemia
- C. Raised LH, Raised FSH (Correct Answer)
- D. Hyperandrogenism
Menstrual Disorders Explanation: ***Raised LH, Raised FSH***
- In **Polycystic Ovarian Syndrome (PCOS)**, the characteristic LH/FSH ratio is typically **high LH and low-to-normal FSH**, not elevated levels of both.
- A simultaneous elevation of both **LH and FSH** is more indicative of **primary ovarian failure** rather than PCOS, as the ovaries would no longer be producing sufficient hormones, leading to increased pituitary stimulation.
*Raised LH, Low-to-normal FSH*
- This hormonal pattern is a hallmark of **PCOS**, where the **increased LH** stimulates the ovarian theca cells to produce excess androgens.
- The **low or normal FSH** prevents proper follicular development, contributing to anovulation and cyst formation.
*Hyperinsulinaemia*
- **Insulin resistance** and compensatory **hyperinsulinaemia** are very common findings in PCOS, driving increased ovarian androgen production.
- High insulin levels potentiate the effect of LH on ovarian androgen synthesis and suppress hepatic production of sex hormone-binding globulin (SHBG).
*Hyperandrogenism*
- **Hyperandrogenism**, characterized by elevated levels of androgens (e.g., testosterone), is a central feature of PCOS and responsible for symptoms like hirsutism, acne, and alopecia.
- This excess androgen production originates primarily from the ovaries and, to some extent, the adrenal glands, often exacerbated by hyperinsulinaemia.
Menstrual Disorders Indian Medical PG Question 4: What is the investigation of choice in postmenopausal bleeding?
- A. PAP smear
- B. Laparoscopy
- C. Fractional curettage
- D. Ultrasound (Correct Answer)
Menstrual Disorders Explanation: ***Ultrasound***
- An initial **transvaginal ultrasound** is the investigation of choice to assess the endometrial thickness in postmenopausal bleeding. An endometrial thickness of >4-5mm often warrants further investigation.
- It helps in **ruling out endometrial pathologies** like hyperplasia, polyps, or carcinoma.
*PAP smear*
- A **PAP smear** is a screening test for cervical cancer, not typically used to investigate postmenopausal bleeding originating from the uterus.
- While it can detect some endometrial cells, it is **not sensitive** or specific enough to diagnose the cause of postmenopausal bleeding.
*Laparoscopy*
- **Laparoscopy** is a surgical procedure used to visualize pelvic organs and is generally employed for diagnosing and treating conditions like endometriosis, ovarian cysts, or ectopic pregnancies.
- It is **not the initial investigation** for postmenopausal bleeding and is too invasive for primary diagnosis unless other methods have failed or a specific pathology is suspected.
*Fractional curettage*
- **Fractional curettage** involves scraping the lining of the cervix and uterus to obtain tissue samples for histological examination.
- While it can be diagnostic for endometrial pathology, it is typically performed **after an initial ultrasound** has identified increased endometrial thickness or other suspicious findings, and less commonly as a standalone initial investigation.
Menstrual Disorders Indian Medical PG Question 5: Heavy menstrual bleeding is a common presentation in which of the following?
1. Clotting factor deficiency
2. Fibroid uterus
3. Adenomyosis
4. Prolactinoma.
- A. 1, 2 and 3 (Correct Answer)
- B. 2, 3 and 4
- C. 1, 2 and 4
- D. 1, 3 and 4
Menstrual Disorders Explanation: ***1, 2 and 3***
- **Clotting factor deficiencies** (e.g., von Willebrand disease, factor XI deficiency) impair normal hemostasis, leading to prolonged and heavy menstrual bleeding.
- **Fibroid uterus** causes heavy menstrual bleeding due to increased endometrial surface area, impaired uterine contractility, and dilated underlying vessels.
- **Adenomyosis**, characterized by endometrial tissue within the myometrium, leads to an enlarged, boggy uterus and causes heavy and painful menstruation.
*2, 3 and 4*
- This option correctly identifies fibroid uterus and adenomyosis, which are common causes of heavy menstrual bleeding.
- However, **prolactinoma** typically causes **amenorrhea** or oligomenorrhea, not heavy menstrual bleeding, due to its inhibitory effect on gonadotropin-releasing hormone (GnRH).
*1, 2 and 4*
- While clotting factor deficiency and fibroid uterus are valid causes of heavy menstrual bleeding, **prolactinoma** is an incorrect inclusion.
- Prolactinoma often leads to **hypogonadism** and anovulation, resulting in irregular or absent menstrual periods.
*1, 3 and 4*
- This option includes clotting factor deficiency and adenomyosis, which are causes of heavy menstrual bleeding.
- However, **prolactinoma** is not associated with heavy menstrual bleeding; instead, it is known to cause **menstrual irregularities** including amenorrhea.
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