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?
Which organism causes puerperal sepsis?
Which condition is associated with HAIR-AN syndrome?
Which of the following statements about gestational diabetes mellitus (GDM) is true?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 21: 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 22: 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 23: 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 24: 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 25: 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 26: 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 27: 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 28: 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 29: 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 30: Which of the following statements about gestational diabetes mellitus (GDM) is true?
- A. It is always associated with a previous history of IUGR.
- B. There is no recurrence of GDM in future pregnancies.
- C. There is no risk of developing overt diabetes in the future.
- D. Gestational diabetes mellitus is first recognized during pregnancy. (Correct Answer)
Explanation: ***Gestational diabetes mellitus is first recognized during pregnancy.*** - GDM is defined as **glucose intolerance** that is first recognized or diagnosed during pregnancy, regardless of whether it requires insulin or persists after pregnancy. - This definition distinguishes it from **pre-existing type 1 or type 2 diabetes** diagnosed before conception. *It is always associated with a previous history of IUGR.* - GDM is primarily associated with an increased risk of **macrosomia** (large-for-gestational-age babies) due to high maternal glucose levels stimulating fetal insulin production and growth. - While other pregnancy complications can occur, **intrauterine growth restriction (IUGR)** is not a typical or consistent association with GDM. *There is no recurrence of GDM in future pregnancies.* - Women who have had GDM in one pregnancy have a **significantly increased risk** (30-50%) of developing it again in subsequent pregnancies. - This recurrence risk highlights the underlying predisposition to glucose intolerance. *There is no risk of developing overt diabetes in the future.* - A history of GDM is a strong predictor for developing **type 2 diabetes** later in life, with up to 50% of women developing it within 5-10 years post-delivery. - It also carries a small increased risk of developing **type 1 diabetes** in some individuals.