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?
In which part of the fallopian tube is ectopic pregnancy most likely to survive longer?
Which is false about stress urinary incontinence?
Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?
Most common antigen involved in erythroblastosis fetalis is:
Hydrocephalus is best detected antenatally by :
Which of the following conditions is most commonly associated with malodorous vaginal discharge?
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 41: 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 42: 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 43: 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 44: 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 45: 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 46: Which is false about stress urinary incontinence?
- A. More common in men (Correct Answer)
- B. It is due to weakening of pelvic floor muscles
- C. Prostate surgery may be a cause
- D. It occurs during increased abdominal pressure
Explanation: ***More common in men*** - **Stress urinary incontinence (SUI)** is significantly more prevalent in **women** due to anatomical differences and factors like childbirth. - While it can occur in men, especially after prostate surgery, the overall incidence is higher in females. *It is due to weakening of pelvic floor muscles* - Weakening of the **pelvic floor muscles** is a primary cause of SUI, leading to insufficient support for the urethra and bladder neck. - This weakness compromises the ability to maintain urethral closure pressure during activity. *Prostate surgery may be a cause* - **Radical prostatectomy** for prostate cancer is a common cause of SUI in men, as it can damage the urethral sphincter. - Damage to the internal or external urethral sphincter during surgery impairs the ability to control urine flow. *It occurs during increased abdominal pressure* - SUI characteristically involves involuntary urine leakage during activities that increase **intra-abdominal pressure**, such as coughing, sneezing, laughing, or exercising. - This increased pressure overcomes the weakened urethral resistance, leading to urine loss.
Question 47: Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?
- A. Cervical intraepithelial Neoplasia (Correct Answer)
- B. Ductal carcinoma in situ of breast
- C. Lobular carcinoma in situ of breast
- D. Vaginal intraepithelial neoplasia
Explanation: ***Cervical intraepithelial neoplasia (CIN)*** - CIN has a high success rate with treatment (e.g., **cryotherapy**, **LEEP**), often completely eradicating the dysplastic cells and preventing progression to **invasive cervical cancer**. - The effectiveness of screening via **Pap smears** allows for early detection and intervention, significantly reducing cancer risk. *Ductal carcinoma in situ (DCIS) of breast* - While treatable, DCIS carries a higher risk of recurrence and progression to **invasive breast cancer** in the same or contralateral breast compared to CIN. - Treatment often involves **lumpectomy** with or without radiation, and sometimes **total mastectomy**, reflecting its more serious potential. *Lobular carcinoma in situ (LCIS) of breast* - LCIS is largely considered a **risk indicator** for future invasive cancer in either breast, rather than a direct precursor that inevitably progresses. - Management often involves **close surveillance** or **chemoprevention**, as surgical excision does not prevent cancer development in other areas of the breast. *Vaginal intraepithelial neoplasia (VAIN)* - While treatable, VAIN is less common and often coexists with or follows **cervical or vulvar neoplasia**, indicating a broader field defect due to **HPV**. - Recurrence rates post-treatment can be significant, and patients often require long-term follow-up due to the continued risk of progression.
Question 48: 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 49: Hydrocephalus is best detected antenatally by :
- A. X-ray abdomen
- B. Amniocentesis
- C. Clinical examination
- D. Ultrasonography (Correct Answer)
Explanation: ***Ultrasonography*** - **Antenatal ultrasonography** is the primary and most effective method for detecting fetal hydrocephalus. - It allows direct visualization of **ventricular dilation**, the key diagnostic finding in hydrocephalus (lateral ventricles >10mm at atrium level). - USG is **safe, non-invasive**, and can be performed repeatedly without radiation exposure. - It also helps identify associated anomalies and determine the cause of hydrocephalus. *X-ray abdomen* - **X-rays** expose the fetus to **ionizing radiation**, posing risks and violating ALARA (As Low As Reasonably Achievable) principles. - They provide limited detail of **soft tissue structures** like brain ventricles, making them unsuitable for diagnosing hydrocephalus. - X-rays are not used for antenatal diagnosis of fetal brain abnormalities. *Amniocentesis* - **Amniocentesis** is primarily used for **chromosomal analysis** and genetic testing, not for direct visualization of brain anomalies. - While some genetic conditions can lead to hydrocephalus, amniocentesis doesn't directly detect the hydrocephalus itself. - It cannot visualize structural fetal abnormalities. *Clinical examination* - **Antenatal clinical examination** of the mother cannot directly assess fetal brain abnormalities. - It may suggest fetal issues if there is an abnormally large uterine size or polyhydramnios, but it **lacks the specificity and sensitivity** to diagnose hydrocephalus. - Clinical examination alone is inadequate for detecting structural fetal anomalies.
Question 50: Which of the following conditions is most commonly associated with malodorous vaginal discharge?
- A. Bacterial vaginosis (Correct Answer)
- B. Chlamydia trachomatis
- C. Trichomonas vaginalis
- D. Neisseria gonorrhoeae
Explanation: ***Bacterial vaginosis*** - This condition is characterized by a "fishy" or **malodorous vaginal discharge**, particularly noticeable after intercourse due to the release of amines. - It results from an imbalance in the vaginal flora, with an overgrowth of anaerobic bacteria and a decrease in protective lactobacilli. *Chlamydia trachomatis* - Often presents with **asymptomatic cervicitis** or mild watery discharge; **malodorous discharge** is not a common or prominent symptom. - While it can cause pelvic pain or dysuria, it's not typically associated with the characteristic smell of bacterial vaginosis. *Trichomonas vaginalis* - Can cause a **frothy, yellow-green discharge** that may be malodorous, but the "fishy" odor is more classically associated with bacterial vaginosis. - Other common symptoms include intense itching, burning, and dyspareunia. *Neisseria gonorrhoeae* - Causes cervicitis, which can lead to a **purulent or mucopurulent vaginal discharge**, but it does not typically produce the distinctive malodor seen in bacterial vaginosis. - Infection can also manifest as dysuria, pelvic pain, or be asymptomatic.