Puerperium: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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OBG · Puerperium

Sample item

A 28-year-old woman had severe postpartum haemorrhage with shock. Six months later she has failure of lactation, amenorrhoea, fatigue and loss of pubic hair. What is the most likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Sheehan syndrome

Severe obstetric haemorrhage with hypotension can cause ischaemic necrosis of the enlarged pituitary, giving hypopituitarism. The first sign is often failure to lactate, followed by amenorrhoea and secondary adrenal and thyroid failure. Diagnosis is confirmed by low pituitary hormones and imaging.

Option by option

  • A. Sheehan syndrome (correct)

    Correct. Pituitary infarction after haemorrhage explains the loss of several hormone axes.

  • B. Polycystic ovary syndrome

    PCOS causes oligomenorrhoea with hyperandrogenism, not hypopituitarism.

  • C. Premature ovarian insufficiency

    Ovarian insufficiency would not cause lactation failure related to the haemorrhage or adrenal and thyroid failure.

  • D. Asherman syndrome

    Asherman syndrome causes amenorrhoea from intrauterine adhesions but not lactation failure or hair loss.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is A, Sheehan syndrome. Severe obstetric haemorrhage with hypotension can cause ischaemic necrosis of the enlarged pituitary, giving hypopituitarism.

Why is "Polycystic ovary syndrome" not the answer?

PCOS causes oligomenorrhoea with hyperandrogenism, not hypopituitarism.

Why is "Premature ovarian insufficiency" not the answer?

Ovarian insufficiency would not cause lactation failure related to the haemorrhage or adrenal and thyroid failure.

Why is "Asherman syndrome" not the answer?

Asherman syndrome causes amenorrhoea from intrauterine adhesions but not lactation failure or hair loss.

What concept does this question test?

It tests Puerperium in OBG. The first sign is often failure to lactate, followed by amenorrhoea and secondary adrenal and thyroid failure. Diagnosis is confirmed by low pituitary hormones and imaging.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Puerperium?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.