NEET-PG 2013 - Obstetrics and Gynecology Practice Questions

Q: Which condition is associated with HAIR-AN syndrome?

Polycystic Ovary Syndrome (PCOS). ***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.

Q: Which hormone is known to be elevated in Polycystic Ovary Syndrome (PCOS)?

Luteinizing Hormone (LH). ***Luteinizing Hormone (LH)*** - In **Polycystic Ovary Syndrome (PCOS)**, there is often an elevated **Luteinizing Hormone (LH)** level, leading to an increased **LH:FSH ratio**. - This high LH level contributes to **increased androgen production** by the ovaries, a key feature of PCOS. *FSH* - **Follicle-stimulating hormone (FSH)** levels are typically normal or even low in PCOS, contributing to the **imbalance with LH**. - This relative deficiency of FSH impairs proper **follicle maturation**, leading to anovulation and cyst formation. *Estrogen* - While **estrogen** levels can be normal or slightly elevated due to peripheral conversion of androgens, they are not primarily responsible for the characteristic hormonal imbalance in PCOS. - The elevated **androgens** in PCOS are converted to estrogen in adipose tissue, but this is a secondary effect. *TSH* - **Thyroid-stimulating hormone (TSH)** is involved in thyroid function and is generally unrelated to the **pathophysiology of PCOS**, although thyroid disorders can co-exist with PCOS. - Elevated TSH suggests **hypothyroidism**, a distinct endocrine condition that would present with different symptoms.

Q: In Stein-Leventhal syndrome, which hormone is raised?

LH. ***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.

Q: What is the most likely cause of yellow-green watery discharge and pruritus in a female patient?

Trichomonas vaginalis. ***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). *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.

Q: The 'T' sign is associated with which condition?

Monochorionic twin pregnancy. ***Monochorionic twin pregnancy*** - The **'T' sign** on ultrasound is highly suggestive of a **monochorionic twin pregnancy**, indicating shared placenta and a thin inter-twin membrane that meets the chorion at a sharp, T-shaped angle. - This sign identifies the absence of a chorionic plate extending into the inter-twin membrane, distinguishing it from thick-membraned dichorionic pregnancies. *Dichorionic twin pregnancy* - Dichorionic pregnancies typically exhibit the **'lambda' or 'twin peak' sign**, where the chorion extends into the inter-twin membrane, creating a triangular projection, not a 'T' shape. - This sign indicates two separate placentas (or fused but distinct placentas) and two chorions, leading to a thicker inter-twin membrane. *Normal singleton pregnancy* - A normal singleton pregnancy involves only one fetus, and therefore no inter-twin membrane or associated signs like the 'T' or 'lambda' sign are present. - The concept of chorionicity and amnionicity is specific to multiple gestations, particularly twin pregnancies. *Multiple gestation* - While a monochorionic twin pregnancy is a type of multiple gestation, the term "multiple gestation" is too broad and does not specifically identify the **'T' sign**. - Multiple gestation can be either monochorionic or dichorionic, and only monochorionic pregnancies are associated with the 'T' sign.

Q: At which gestational week does the maximum volume of amniotic fluid occur?

36 weeks. ***36 weeks*** - The volume of **amniotic fluid** gradually increases during pregnancy, reaching its **peak** around **36 weeks** of gestation. - After 36 weeks, the volume of amniotic fluid typically begins to **decrease** as the pregnancy approaches term. *32 weeks* - At 32 weeks, the amniotic fluid volume is still **increasing** and has not yet reached its maximum level. - The fetus is actively growing and contributing to fluid production, but the peak is still several weeks away. *34 weeks* - Although significant, the amniotic fluid volume at 34 weeks has not yet reached its **maximum**. - The volume will continue to rise for another two weeks before plateauing and then declining. *40 weeks* - By 40 weeks, a normal-term pregnancy, the volume of amniotic fluid has typically **decreased** from its peak at 36 weeks. - A declining amniotic fluid volume (oligohydramnios) can be a concern at term if it's too low.

Q: Uterine rupture is most common in -

Anterior lower segment. ***Anterior lower segment*** - The **anterior lower segment** is the most common site for **uterine rupture** due to prior **cesarean sections** or other uterine surgeries which are often performed anteriorly. - This area is thinner and more prone to stretching and tearing during labor, especially in cases of repeated surgical scars. *Posterior lower segment* - While rupture can occur in the **posterior lower segment**, it is less common than the anterior location. - This area is usually less stressed by previous surgical incisions compared to the anterior wall. *Upper uterine segment* - Rupture in the **upper uterine segment** typically involves an **unscarred uterus** and is a rare event, often associated with a **grand multiparous patient** or **oxytocin hyperstimulation**. - This type of rupture is usually spontaneous and more catastrophic due to the rich vascularity of the upper segment. *Lateral uterine wall* - Rupture of the **lateral uterine wall** is uncommon and usually associated with **trauma** or **manual extraction of the placenta**, rather than prior surgical scars. - It is not the most frequent site for spontaneous or scar-related uterine rupture.

Q: Which nerve block is given in forceps delivery?

Pudendal. ***Pudendal*** - A **pudendal block** anesthetizes the **perineum, vulva, and lower vagina**, providing pain relief for instrumental deliveries like **forceps delivery** and for episiotomy. - It involves injecting a local anesthetic near the **pudendal nerve** as it passes posterior to the **ischial spine**. *Posterior femoral* - The **posterior femoral cutaneous nerve** primarily innervates the skin of the posterior thigh and part of the perineum but does not provide sufficient deep analgesia for a forceps delivery. - Blocking this nerve alone would not adequately cover the extensive area affected during instrumental delivery. *Genitofemoral* - The **genitofemoral nerve** primarily innervates the skin of the upper medial thigh and parts of the genitalia but is not the primary nerve for pain relief during vaginal delivery procedures. - Its blockade would not provide the comprehensive analgesia needed for a forceps delivery. *Ilio inguinal* - The **ilioinguinal nerve** innervates the skin of the groin, mons pubis, and labia majora but does not provide sufficient anesthesia for the deeper structures involved in a forceps delivery. - An ilioinguinal nerve block is more commonly used for pain control in procedures involving the groin or hernia repair, not for instrumental vaginal delivery.

Question 1

Which condition is associated with HAIR-AN syndrome?

Accepted Answer

Polycystic Ovary Syndrome (PCOS)

Answer

CA ovary

Answer

Adrenal tumours

Answer

Endometriosis

Question 2

Which hormone is known to be elevated in Polycystic Ovary Syndrome (PCOS)?

Accepted Answer

Luteinizing Hormone (LH)

Answer

FSH

Answer

Estrogen

Answer

TSH

Question 3

In Stein-Leventhal syndrome, which hormone is raised?

Accepted Answer

LH

Answer

FSH

Answer

GnRH

Answer

Progesterone

Question 4

Which of the following actions should be avoided during the delivery of an Rh-negative mother?

Accepted Answer

Gently perform manual removal of placenta if necessary

Answer

Withhold ergometrine until after anterior shoulder delivery

Answer

Administer IV fluids

Answer

Apply fundal pressure during second stage of labor

Question 5

What is the most likely cause of yellow-green watery discharge and pruritus in a female patient?

Accepted Answer

Trichomonas vaginalis

Answer

Candida

Answer

Bacterial vaginosis

Answer

Chlamydia trachomatis

Question 6

The 'T' sign is associated with which condition?

Accepted Answer

Monochorionic twin pregnancy

Answer

Dichorionic twin pregnancy

Answer

Normal singleton pregnancy

Answer

Multiple gestation

Question 7

At which gestational week does the maximum volume of amniotic fluid occur?

Accepted Answer

36 weeks

Answer

32 weeks

Answer

34 weeks

Answer

40 weeks

Question 8

Uterine rupture is most common in -

Accepted Answer

Anterior lower segment

Answer

Posterior lower segment

Answer

Upper uterine segment

Answer

Lateral uterine wall

Question 9

Which nerve block is given in forceps delivery?

Accepted Answer

Pudendal

Answer

Posterior femoral

Answer

Genitofemoral

Answer

Ilioinguinal

NEET-PG 2013 — Obstetrics and Gynecology