Obstetrics and Gynecology
10 questionsWhich of the following is not considered a marker of ovarian reserve?
Which of the following is a side effect of Progestin Only Pills (POPs)?
Which of the following is not associated with maternal age?
What should be done if 2 OCPs are missed on days 17-18 of the cycle?
Most common complication of dermoid cyst is -
What is a common cause of unilateral dysmenorrhea?
What is the most appropriate management for a 28-year-old hemodynamically stable patient with mild abdominal pain and an unruptured tubal ectopic pregnancy measuring 2.5 x 3 cm, with β-hCG level of 8500 mIU/mL, visible fetal cardiac activity, and who desires future fertility?
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?
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1011: Which of the following is not considered a marker of ovarian reserve?
- A. Ovarian volume
- B. Inhibin B
- C. Anti-Müllerian Hormone (AMH)
- D. Inhibin A (Correct Answer)
Explanation: ***Inhibin A*** - **Inhibin A** levels primarily rise during the mid to late luteal phase and are involved in regulating FSH, but they are not a reliable or commonly used marker for **ovarian reserve**. - Its fluctuations are more indicative of the presence of a **corpus luteum** and short-term ovarian function rather than the total follicular pool. *Inhibin B* - **Inhibin B** is produced by granulosa cells of small antral follicles and is an important marker of **ovarian reserve**. - It inversely correlates with **FSH** levels in the early follicular phase, reflecting the number of developing follicles. *Ovarian volume* - **Ovarian volume**, particularly when measured by ultrasound, can be an indicator of **ovarian reserve**. - Smaller ovarian volume is generally associated with a reduced number of **antral follicles** and lower ovarian reserve. *Anti-Müllerian Hormone (AMH)* - **AMH** is a well-established and highly reliable marker of **ovarian reserve**, produced by the granulosa cells of preantral and small antral follicles. - Its levels correlate directly with the total number of remaining **primordial follicles** and are relatively stable throughout the menstrual cycle.
Question 1012: Which of the following is a side effect of Progestin Only Pills (POPs)?
- A. Ovarian cysts (Correct Answer)
- B. Venous thromboembolism
- C. Increased risk of diabetes mellitus
- D. Ectopic pregnancy
Explanation: ***Ovarian cysts*** - **Functional ovarian cysts** are a known side effect of Progestin Only Pills (**POPs**), as POPs can alter the normal ovulatory cycle but usually do not completely suppress follicular development. - While generally benign and self-resolving, they can cause pain and discomfort. *Venous thromboembolism* - **POPs** are not significantly associated with an increased risk of **venous thromboembolism** due to the absence of estrogen, unlike combined hormonal contraceptives. - This is a key advantage of POPs, making them suitable for individuals at risk for thromboembolic events. *Increased risk of diabetes mellitus* - There is generally **no significant increased risk** of **diabetes mellitus** associated with POPs. - While some hormonal contraceptives *may* have minor effects on glucose metabolism, this is not a prominent or clinically significant side effect of POPs. *Ectopic pregnancy* - POPs **do not increase the risk of ectopic pregnancy**. In fact, they **reduce the overall pregnancy rate**, including ectopic pregnancies, by preventing ovulation. - However, if a pregnancy does occur while on POPs, there is a *slightly higher proportion* of those pregnancies that may be ectopic compared to unaided conceptions, but the *absolute risk* remains low.
Question 1013: Which of the following is not associated with maternal age?
- A. Preterm labour
- B. Aneuploidy
- C. Hydatidiform mole
- D. Post maturity (Correct Answer)
Explanation: ***Post maturity*** - **Post-maturity** (post-term pregnancy, >42 weeks) does NOT have a consistent or strong association with maternal age in current obstetric literature. - While some older studies suggested associations, modern evidence shows **no significant independent effect of maternal age** on post-term pregnancy rates. - Post-term pregnancy is more related to factors like **first pregnancy**, **prior post-term delivery**, and **fetal sex** (males more common). *Preterm labour* - **Preterm birth is strongly associated with maternal age**, particularly at both extremes: - **Teenage mothers** (<20 years): Increased risk due to biological immaturity and socioeconomic factors - **Advanced maternal age** (≥35 years): Increased risk due to higher rates of maternal complications (hypertension, diabetes) and placental dysfunction - This is well-established in obstetric literature and clinical guidelines. *Aneuploidy* - The risk of **aneuploidy**, particularly **Down syndrome (Trisomy 21)**, **increases dramatically with advancing maternal age**. - At age 35: ~1/350 risk; at age 40: ~1/100 risk; at age 45: ~1/30 risk - Due to age-related decline in oocyte quality causing meiotic errors during egg formation. *Hydatidiform mole* - **Gestational trophoblastic disease** (hydatidiform mole) is strongly associated with **extremes of maternal age**: - **Women >40 years**: 5-10 fold increased risk - **Teenagers**: 1.5-2 fold increased risk - Related to abnormal fertilization events more common at age extremes.
Question 1014: What should be done if 2 OCPs are missed on days 17-18 of the cycle?
- A. Take 2 pills on the next 2 days
- B. Continue taking single pill per day
- C. Use back up contraceptive
- D. Both a and b (Correct Answer)
Explanation: ***Both a and b*** - When **two OCPs are missed** on days 17-18 (Week 3) of the cycle, the recommended approach combines two actions to restore contraceptive protection. - The woman should **take two pills on the next two days** to compensate for the missed doses and restore hormonal levels quickly. - Additionally, **backup contraception should be used for at least 7 days** to ensure contraceptive effectiveness, as the missed pills during Week 3 could compromise protection and increase the risk of ovulation. - Both actions together address the hormonal gap and provide adequate contraceptive coverage. *Take 2 pills on the next 2 days* - While this action helps **reestablish hormone levels** after missing two pills, it is **insufficient on its own**. - Without concurrent backup contraception, there remains a risk of **ovulation** and **unintended pregnancy** during the recovery period. - This must be combined with backup contraceptive methods for 7 days. *Use back up contraceptive* - Using **backup contraception** is essential because missing two pills in Week 3 increases the risk of **ovulation**. - However, backup contraception alone without resuming the pill regimen (with catch-up dosing) would not adequately restore the hormonal cycle. - Both resuming pills appropriately and using backup methods are necessary. *Continue taking single pill per day* - Simply continuing with one pill per day without any catch-up dosing would leave a **hormonal gap** from the two missed pills. - This approach does not compensate for the **missed active hormones**, leaving inadequate hormone levels for contraceptive protection. - Without catch-up dosing and backup contraception, the risk of **ovulation** and **pregnancy** remains significantly elevated.
Question 1015: Most common complication of dermoid cyst is -
- A. Cyst Rupture
- B. Torsion (Correct Answer)
- C. Malignant degeneration
- D. Infection
Explanation: ***Torsion*** - Ovarian dermoid cysts (mature cystic teratomas) are prone to **torsion** due to their common unilateral, round, and easily mobile nature. - Torsion results from the **twisting of the ovarian pedicle**, which can lead to exquisite pain and potential **ischemic necrosis** of the ovary. - **Most common complication** occurring in **15-20% of dermoid cysts**. *Cyst Rupture* - While rupture can occur, it is a **less common complication** than torsion, occurring in **1-4% of cases**. - Rupture can release sebaceous material and hair into the peritoneal cavity, leading to **chemical peritonitis**. *Malignant degeneration* - **Malignant transformation** within a dermoid cyst is rare, occurring in **less than 1-2% of cases**, making it much less common than torsion. - The most common type of malignancy arising from a dermoid cyst is **squamous cell carcinoma**. *Infection* - **Secondary infection** of dermoid cysts is a rare complication. - Much less common than torsion, and typically presents with fever, pain, and signs of inflammation.
Question 1016: What is a common cause of unilateral dysmenorrhea?
- A. One horn of malformed uterus (Correct Answer)
- B. Small fibroid at the utero tubal junction
- C. Endometriosis causing unilateral pain
- D. All of the options
Explanation: ***One horn of malformed uterus*** - **Obstructed rudimentary horn** with functional endometrium or **obstructed hemivagina** in uterine anomalies is a **classic cause of unilateral dysmenorrhea**. - The obstruction leads to accumulation of menstrual blood in the non-communicating horn or hemivagina, causing **severe cyclical unilateral pelvic pain** that worsens progressively with each menstrual cycle. - This typically presents in **adolescents or young women** after menarche and is a well-recognized gynecological emergency requiring surgical intervention. - Examples include: **unicornuate uterus with non-communicating rudimentary horn**, **uterus didelphys with obstructed hemivagina** (OHVIRA syndrome). *Endometriosis causing unilateral pain* - While endometriosis causes **dysmenorrhea**, it typically presents with **bilateral pelvic pain** and diffuse tenderness. - Endometriosis pain is usually **generalized** rather than strictly unilateral, though asymmetric involvement can occur. - The pain is associated with **deep dyspareunia**, **dyschezia**, and chronic pelvic pain rather than strictly unilateral cyclical pain. *Small fibroid at the utero tubal junction* - Fibroids (leiomyomas) can cause **dysmenorrhea and menorrhagia**, but unilateral presentation is uncommon. - Cornual fibroids may cause localized pain, but this is not a typical or common presentation of **unilateral dysmenorrhea**. - Pain from fibroids is usually related to **degeneration** or pressure effects rather than cyclical unilateral menstrual pain. *All of the options* - While multiple conditions can cause pelvic pain, **obstructed müllerian anomalies** (one horn of malformed uterus) are the **most classic and important cause** of true unilateral dysmenorrhea. - This is the diagnosis that must be ruled out when a patient presents with unilateral cyclical pelvic pain.
Question 1017: What is the most appropriate management for a 28-year-old hemodynamically stable patient with mild abdominal pain and an unruptured tubal ectopic pregnancy measuring 2.5 x 3 cm, with β-hCG level of 8500 mIU/mL, visible fetal cardiac activity, and who desires future fertility?
- A. Methotrexate therapy
- B. Laparoscopic salpingostomy (Correct Answer)
- C. Laparoscopic salpingectomy
- D. Expectant management
Explanation: ***Laparoscopic salpingostomy*** - This patient desires future fertility, making **salpingostomy** (tube-preserving surgery) the most appropriate management. - Salpingostomy involves making an incision in the fallopian tube, removing the ectopic pregnancy, and leaving the tube intact to preserve fertility potential. - While the presence of **fetal cardiac activity** and **β-hCG of 8500 mIU/mL** contraindicate medical management, they do not contraindicate conservative surgical management in a hemodynamically stable patient. - The patient meets criteria for conservative surgery: hemodynamically stable, unruptured ectopic, and desires future fertility. *Methotrexate therapy* - This patient has **absolute contraindications for methotrexate**: β-hCG level >5000 mIU/mL (here 8500) and presence of **fetal cardiac activity**. - Methotrexate is only suitable for hemodynamically stable patients with ectopic mass <3.5-4 cm, β-hCG <5000 mIU/mL, no fetal cardiac activity, and normal liver/renal function. - The high β-hCG and cardiac activity indicate a viable ectopic pregnancy that is unlikely to respond to medical management. *Laparoscopic salpingectomy* - Salpingectomy involves **complete removal of the affected fallopian tube**, which significantly reduces future fertility if this is the only functional tube or if the contralateral tube is damaged. - This option is preferred when: the tube is severely damaged, there is uncontrolled bleeding, recurrent ectopic in the same tube, or the patient does not desire future fertility. - Since this patient **specifically desires future fertility** and is hemodynamically stable with an unruptured ectopic, salpingostomy (tube preservation) is preferred over salpingectomy. *Expectant management* - Expectant management requires **very low or declining β-hCG levels** (typically <1000-1500 mIU/mL), absence of fetal cardiac activity, and very small ectopic size (<2 cm). - This patient has β-hCG of 8500 mIU/mL with **visible fetal cardiac activity**, indicating a viable growing ectopic pregnancy with high rupture risk. - These findings make expectant management unsafe and inappropriate.
Question 1018: 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 1019: 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 1020: 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.