Fifteen minutes after delivery in the labour room, a woman with pre-eclampsia (BP 158/104 mmHg) and long-standing bronchial asthma on inhalers is bleeding heavily from an atonic uterus. Oxytocin 10 IU IM and then an oxytocin infusion, bimanual compression and tranexamic acid 1 g IV have been given, but bleeding continues. The placenta was delivered complete, there are no genital tract tears, and her pulse is 112/min with cool peripheries. She had a severe asthma attack needing intensive care two years ago. Which additional uterotonic is most appropriate?

Dinoprostone gel in the posterior fornix

Six weeks ago, a toddler with Kawasaki disease received high-dose IVIG (2 g/kg). He is now 16 months old, well, and due for his second dose of measles-rubella vaccine at the Anganwadi session today. He has no fever and has finished his aspirin course, and his coronary echo was normal. What is the correct plan for the MR vaccine?

Skip it, as IVIG gives lasting immunity

Give it today and repeat after 4 weeks

A premenopausal schoolteacher with regular periods has had surgery for an oestrogen receptor-positive breast cancer. A relative who took letrozole for her own breast cancer suggests the same drug alone. She is 41, her tumour is HER2-negative, and she has no history of thrombosis. Why is an aromatase inhibitor alone unsuitable for her?

Low oestrogen raises FSH and LH, driving the ovaries

Aromatase is absent in premenopausal women

Aromatase inhibitors do not work in ER-positive disease

Letrozole is toxic to functioning ovaries

Sex hormones, contraceptives, uterine drugs and vaccines

33 NEET-PG practice questions on Sex hormones, contraceptives, uterine drugs and vaccines, part of Pharmacology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Easy
Postmenopausal bleeding in a woman taking tamoxifen for breast cancer is most worrying for which condition?
1. AEndometrial carcinoma
2. BAtrophic vaginitis
3. CCervical ectropion
4. DOvarian granulosa cell tumour
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Answer: A · Endometrial carcinoma
Tamoxifen is an oestrogen antagonist in breast tissue but a partial agonist in the endometrium, raising the risk of endometrial hyperplasia, polyps and carcinoma about two- to threefold. Any postmenopausal bleeding on tamoxifen needs transvaginal ultrasound and endometrial biopsy. Raloxifene does not stimulate the endometrium.
- B: Atrophic vaginitis is common, but on tamoxifen cancer must be excluded first.
- C: Ectropion is a benign cervical finding, not linked to tamoxifen.
- D: Granulosa cell tumours are rare and unrelated to tamoxifen.
Remember this
Tamoxifen is an endometrial agonist: bleeding on it needs evaluation for endometrial cancer.
Question 2 · Hard
Fifteen minutes after delivery in the labour room, a woman with pre-eclampsia (BP 158/104 mmHg) and long-standing bronchial asthma on inhalers is bleeding heavily from an atonic uterus. Oxytocin 10 IU IM and then an oxytocin infusion, bimanual compression and tranexamic acid 1 g IV have been given, but bleeding continues. The placenta was delivered complete, there are no genital tract tears, and her pulse is 112/min with cool peripheries. She had a severe asthma attack needing intensive care two years ago. Which additional uterotonic is most appropriate?
1. ADinoprostone gel in the posterior fornix
2. BMisoprostol 800 µg sublingual
3. CMethylergometrine 0.2 mg IM
4. DCarboprost 250 µg IM
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Answer: B · Misoprostol 800 µg sublingual
Second-line uterotonics are chosen by contraindications: methylergometrine raises blood pressure and is contraindicated in pre-eclampsia, and carboprost (a PGF2-alpha analogue) causes bronchospasm and is contraindicated in asthma. Misoprostol, a PGE1 analogue, neither constricts bronchi nor raises blood pressure and is the safe choice here, while balloon tamponade or surgery is prepared if bleeding persists. Dinoprostone is for cervical ripening, not PPH.
- A: Dinoprostone is for cervical ripening, not for PPH.
- C: Methylergometrine raises BP and is contraindicated in pre-eclampsia.
- D: Carboprost causes bronchospasm and is contraindicated in asthma.
Remember this
PPH with asthma and pre-eclampsia: avoid carboprost and methylergometrine; use misoprostol.
Question 3 · Medium
Forty minutes after a vaginal delivery at a CHC, a woman is bleeding heavily: about 900 mL so far, uterus boggy. Pulse is 112/min and BP 100/64 mmHg; the placenta was delivered complete. Oxytocin infusion and uterine massage have been started. According to WHO guidance, which drug should also be given now?
1. AProtamine sulphate 50 mg IV
2. BTranexamic acid 1 g IV
3. CDesmopressin 0.3 µg/kg IV
4. DVitamin K 10 mg IV
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Answer: B · Tranexamic acid 1 g IV
WHO recommends IV tranexamic acid 1 g over 10 minutes, as early as possible and within 3 hours of birth, for all women with PPH, in addition to uterotonics; a second dose is given if bleeding continues after 30 minutes or restarts within 24 hours. The WOMAN trial showed fewer deaths from bleeding when it was given early, with no benefit after 3 hours.
- A: Protamine reverses heparin, which she has not received.
- C: Desmopressin is for von Willebrand disease or platelet dysfunction.
- D: Vitamin K corrects vitamin K deficiency, which is not the cause here.
Remember this
For PPH, give tranexamic acid 1 g IV within 3 hours of birth, alongside uterotonics.
Question 4 · Hard
Six weeks ago, a toddler with Kawasaki disease received high-dose IVIG (2 g/kg). He is now 16 months old, well, and due for his second dose of measles-rubella vaccine at the Anganwadi session today. He has no fever and has finished his aspirin course, and his coronary echo was normal. What is the correct plan for the MR vaccine?
1. ASkip it, as IVIG gives lasting immunity
2. BGive it today and repeat after 4 weeks
3. CDefer it for about 11 months
4. DGive it today as scheduled
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Answer: C · Defer it for about 11 months
Passively acquired measles and rubella antibodies in immunoglobulin neutralise the live vaccine viruses, so live vaccines are deferred after immunoglobulin or blood products; the interval depends on the dose, and after high-dose IVIG (2 g/kg) it is about 11 months. If a live vaccine has already been given within this time, it is repeated after the interval. Inactivated vaccines are not affected.
- A: IVIG gives only temporary passive protection.
- B: A repeat at 4 weeks is still within the antibody window.
- D: IVIG antibodies would neutralise the vaccine virus today.
Remember this
Live parenteral vaccines (MR, varicella) are deferred after immunoglobulin; after 2 g/kg IVIG, wait about 11 months.
Question 5 · Hard
A premenopausal schoolteacher with regular periods has had surgery for an oestrogen receptor-positive breast cancer. A relative who took letrozole for her own breast cancer suggests the same drug alone. She is 41, her tumour is HER2-negative, and she has no history of thrombosis. Why is an aromatase inhibitor alone unsuitable for her?
1. ALow oestrogen raises FSH and LH, driving the ovaries
2. BAromatase is absent in premenopausal women
3. CAromatase inhibitors do not work in ER-positive disease
4. DLetrozole is toxic to functioning ovaries
Show answerHide answer
Answer: A · Low oestrogen raises FSH and LH, driving the ovaries
In premenopausal women the ovaries make most oestrogen; an aromatase inhibitor lowers oestrogen and removes negative feedback, so FSH and LH rise and drive the ovaries to overcome the block (it can even induce ovulation). Hence aromatase inhibitors are used only after menopause or together with ovarian suppression (a GnRH agonist or oophorectomy); otherwise tamoxifen is the standard adjuvant endocrine drug.
- B: Aromatase is present in the ovaries and is very active before menopause.
- C: Aromatase inhibitors work well in ER-positive disease after menopause.
- D: Letrozole is not toxic to the ovaries; it stimulates them indirectly.
Remember this
Aromatase inhibitors need ovarian suppression before menopause; otherwise use tamoxifen.
Question 6 · Medium
Before the next 4-hourly IM dose of magnesium sulphate (Pritchard regimen) in a woman with eclampsia, the nurse must confirm: 1. Patellar reflex present 2. Respiratory rate at least 16/min 3. Urine output at least 100 mL in the past 4 hours 4. Blood pressure below 140/90 mmHg. Which are required?
1. A2, 3 and 4
2. B1, 2 and 3
3. C1, 2, 3 and 4
4. D1 and 2
Answer and explanation in LearnFree account
Question 7 · Medium
In the labour room, a woman at 29 weeks is in established preterm labour with 6 cm cervical dilatation; delivery is expected within hours. She has no hypertension, her membranes are intact and she is not febrile. Apart from antenatal steroids already started, which drug, given now, reduces the baby's risk of cerebral palsy?
1. ANifedipine
2. BMagnesium sulphate
3. CVaginal progesterone
4. DIndomethacin
Answer and explanation in LearnFree account
Question 8 · Hard
Eight days ago, a schoolboy was bitten by a monkey on the forearm (two bleeding punctures) and started intradermal rabies vaccine on days 0, 3 and 7 at a CHC, where no immunoglobulin was available. His father now brings him to the district hospital, which stocks rabies immunoglobulin, asking for the 'injection into the wound'. The monkey was a stray in a temple compound and cannot be traced. The boy is well, has had no previous rabies vaccination, and the wound is healing without infection. What is the correct advice?
1. AGive RIG IM in the thigh and continue vaccine
2. BGive RIG into the wound now
3. CRestart the vaccine course with RIG
4. DComplete the vaccine course; no RIG
Answer and explanation in LearnFree account
Question 9 · Medium
At the family planning OPD, a married nurse who does not smoke asks for the combined pill. She sees zigzag lines for 20 minutes before each of her monthly headaches. BP is 118/76 mmHg and BMI 23 kg/m2. She has no other illness and takes no regular medicines. Which is the best advice?
1. ACombined pill is safe if she is under 35
2. BAvoid the combined pill; offer an IUD
3. CCombined pill is safe if headaches are rare
4. DStart the combined pill with low-dose aspirin
Answer and explanation in LearnFree account
Question 10 · Medium
At 33 weeks, a woman in preterm labour at a district hospital is given indomethacin for tocolysis for 4 days by the duty doctor. A fetal echo shows constriction of the ductus arteriosus, and the AFI has fallen to 4 cm. Which effect of the drug explains both findings?
1. AStimulation of beta-2 receptors
2. BInhibition of prostaglandin synthesis
3. CBlockade of oxytocin receptors
4. DBlockade of L-type calcium channels
Answer and explanation in LearnFree account
Question 11 · Easy
Under the nationwide HPV vaccination campaign launched in February 2026, a medical officer plans the session list for a government school. Which group is eligible, and how many doses are given?
1. ABoys and girls aged 11 years; two doses
2. BGirls aged 9-14 years; two doses
3. CWomen aged 15-26 years; three doses
4. DGirls aged 14 years; a single dose
Answer and explanation in LearnFree account
Question 12 · Medium
After 14 hours of high-dose oxytocin infusion in 5% dextrose for induction of labour after an intrauterine fetal death, a woman becomes confused and has a seizure. She has received about 4 litres of fluid, and her urine output has fallen. Serum sodium is 119 mmol/L. Which property of oxytocin explains this?
1. AUterine hyperstimulation causing hypoxia
2. BSodium loss through the uterus
3. CDirect neurotoxicity of oxytocin
4. DAntidiuretic action on renal V2 receptors
Answer and explanation in LearnFree account
Question 13 · Easy
Just after the delivery of a baby in the labour room, a primigravida with severe pre-eclampsia (BP 166/112 mmHg) needs a uterotonic for active management of the third stage. Which drug must be avoided?
1. AMisoprostol
2. BMethylergometrine
3. COxytocin
4. DCarbetocin
Answer and explanation in LearnFree account
Question 14 · Medium
A woman with severe menopausal flushes is obese (BMI 33 kg/m2) and has migraine without aura; she has no personal history of thrombosis. The gynaecologist chooses an oestradiol gel applied to the skin rather than tablets. She is 49 and her last period was 14 months ago. What is the main advantage of this route?
1. ANo first-pass hepatic rise in clotting factors
2. BBetter control of hot flushes than with tablets
3. CNo effect on breast cancer risk
4. DNo need for a progestogen with a uterus
Answer and explanation in LearnFree account
Question 15 · Medium
A woman newly diagnosed with pulmonary TB at a district TB centre is starting the daily regimen of isoniazid, rifampicin, pyrazinamide and ethambutol. She takes a combined pill (Mala-N) and wants no pregnancy for two years. She weighs 46 kg and is HIV negative. What contraceptive advice is best?
1. ARely on the emergency pill as needed
2. BChange to the progestogen-only pill
3. CContinue the same pill unchanged
4. DSwitch to a copper IUD or DMPA
Answer and explanation in LearnFree account
Question 16 · Medium
Hot flushes that wake her several times a night, night sweats and low mood have troubled a schoolteacher for a year since her last period at 51. She has an intact uterus, no history of breast cancer or clotting, and BP 124/80 mmHg. She opts for oestrogen therapy. What must be added?
1. ATestosterone, to improve libido
2. BLow-dose aspirin, to prevent thrombosis
3. CA bisphosphonate, to protect against fracture
4. DA progestogen, to protect the endometrium
Answer and explanation in LearnFree account
Question 17 · Hard
Anovulatory infertility for two years troubles a couple at a district hospital: the woman has PCOS (Rotterdam criteria), BMI 27 kg/m2, normal prolactin and TSH, and patent tubes on HSG, and her husband's semen analysis is normal. Her cycles come every 60-90 days and her AMH is high. Lifestyle changes have been made for six months, and the couple, both 27 and otherwise well, want to avoid injections and a multiple pregnancy if at all possible. Under the 2023 international PCOS guideline, which drug is first-line for ovulation induction?
1. ARecombinant FSH injections
2. BMetformin with clomiphene
3. CLetrozole
4. DClomiphene citrate
Answer and explanation in LearnFree account
Question 18 · Medium
A woman at 31 weeks with preterm prelabour rupture of membranes is admitted to a district hospital; there is no sign of infection. Which corticosteroid regimen best improves the baby's lung maturity?
1. ADexamethasone 6 mg IV, single dose
2. BBetamethasone 12 mg IM, two doses 24 h apart
3. CHydrocortisone 100 mg IV, 8-hourly
4. DPrednisolone 40 mg oral, daily for 5 days
Answer and explanation in LearnFree account
Question 19 · Medium
Antenatal screening at a district hospital showed hepatitis B surface antigen and e antigen in a mother, who has now delivered a term baby weighing 3.1 kg by normal vaginal delivery. The baby cried at birth, and the mother wishes to breastfeed. The paediatric resident is asked to plan prophylaxis. What is the best protection for the newborn?
1. AAvoid breastfeeding and give vaccine at 6 weeks
2. BHBIG alone within 24 hours
3. CHepatitis B vaccine and HBIG within 12 hours
4. DHepatitis B vaccine at 6 weeks only
Answer and explanation in LearnFree account
Question 20 · Medium
A mother of three who has used the injectable 'Antara' (DMPA 150 mg IM every three months) for four years wants another child next year. She is 29, has irregular spotting on the injection, and her last dose was given six weeks ago. Before she stops, which counselling point about this method is most important?
1. AIt must be stopped two years before trying
2. BIt permanently reduces ovarian reserve
3. CFertility may take several months to return
4. DFertility returns within two weeks of stopping
Answer and explanation in LearnFree account
Question 21 · Medium
At a CHC, a farmer bitten by a stray dog 4 hours ago has two deep, bleeding punctures on the calf. He has never had rabies vaccine. The wound has been washed with soap and running water for 15 minutes. He weighs 70 kg. What else must be done today?
1. ASuture the wound and give vaccine
2. BGive vaccine only and observe the dog for 10 days
3. CGive rabies immunoglobulin IM in the buttock only
4. DInfiltrate RIG into the wound and give vaccine
Answer and explanation in LearnFree account
Question 22 · Medium
At 7 weeks' gestation by ultrasound, an intrauterine pregnancy is to be ended medically under the MTP Act. Her haemoglobin is 11.2 g/dL, she has no IUD in place, and she has no adrenal disease or bleeding disorder. The woman receives mifepristone 200 mg orally, then misoprostol 800 µg 24-48 hours later. How does mifepristone contribute?
1. AIt inhibits oestrogen synthesis by aromatase
2. BIt stimulates prostaglandin F2-alpha receptors
3. CIt is an oxytocin receptor agonist
4. DIt blocks progesterone receptors
Answer and explanation in LearnFree account
Question 23 · Medium
After the vaginal delivery of an Rh D-positive baby to an Rh D-negative mother whose indirect Coombs test has been negative throughout pregnancy, what is the correct anti-D prophylaxis?
1. AAnti-D IgG to the newborn baby within 72 hours
2. BNone, as her Coombs test is negative
3. CAnti-D IgG IM within 72 hours of delivery
4. DAnti-D IgG only in the next pregnancy
Answer and explanation in LearnFree account
Question 24 · Hard
A woman comes to the PHC 100 hours after a condom burst. Her last period started 12 days ago and her cycles are regular. She is a nulliparous teacher who is not breastfeeding; her BMI is 31 kg/m2 and she has never had a pelvic infection. A pregnancy test today is negative, she would like a long-term method afterwards, and she has no contraindications to any method. She has heard of levonorgestrel pills but is willing to consider other options. Which is the most effective emergency contraception for her now?
1. ACopper IUD insertion
2. BLevonorgestrel 1.5 mg
3. CTwo combined pills twice (Yuzpe)
4. DUlipristal acetate 30 mg
Answer and explanation in LearnFree account
Question 25 · Medium
Statements about raloxifene used in a postmenopausal woman with osteoporosis: 1. It reduces vertebral fractures. 2. It causes endometrial hyperplasia. 3. It increases the risk of venous thromboembolism. 4. It lowers the risk of invasive oestrogen receptor-positive breast cancer. Which are true?
1. A1, 3 and 4
2. B2 and 4
3. C1 and 3
4. D1, 2 and 3
Answer and explanation in LearnFree account

8 more Sex hormones, contraceptives, uterine drugs and vaccines questions

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Sex hormones, contraceptives, uterine drugs and vaccines

Postmenopausal bleeding in a woman taking tamoxifen for breast cancer is most worrying for which condition?

Before the next 4-hourly IM dose of magnesium sulphate (Pritchard regimen) in a woman with eclampsia, the nurse must confirm: 1. Patellar reflex present 2. Respiratory rate at least 16/min 3. Urine output at least 100 mL in the past 4 hours 4. Blood pressure below 140/90 mmHg. Which are required?

At the family planning OPD, a married nurse who does not smoke asks for the combined pill. She sees zigzag lines for 20 minutes before each of her monthly headaches. BP is 118/76 mmHg and BMI 23 kg/m2. She has no other illness and takes no regular medicines. Which is the best advice?

At 33 weeks, a woman in preterm labour at a district hospital is given indomethacin for tocolysis for 4 days by the duty doctor. A fetal echo shows constriction of the ductus arteriosus, and the AFI has fallen to 4 cm. Which effect of the drug explains both findings?

Under the nationwide HPV vaccination campaign launched in February 2026, a medical officer plans the session list for a government school. Which group is eligible, and how many doses are given?

Just after the delivery of a baby in the labour room, a primigravida with severe pre-eclampsia (BP 166/112 mmHg) needs a uterotonic for active management of the third stage. Which drug must be avoided?

A woman newly diagnosed with pulmonary TB at a district TB centre is starting the daily regimen of isoniazid, rifampicin, pyrazinamide and ethambutol. She takes a combined pill (Mala-N) and wants no pregnancy for two years. She weighs 46 kg and is HIV negative. What contraceptive advice is best?

Hot flushes that wake her several times a night, night sweats and low mood have troubled a schoolteacher for a year since her last period at 51. She has an intact uterus, no history of breast cancer or clotting, and BP 124/80 mmHg. She opts for oestrogen therapy. What must be added?

A woman at 31 weeks with preterm prelabour rupture of membranes is admitted to a district hospital; there is no sign of infection. Which corticosteroid regimen best improves the baby's lung maturity?

At a CHC, a farmer bitten by a stray dog 4 hours ago has two deep, bleeding punctures on the calf. He has never had rabies vaccine. The wound has been washed with soap and running water for 15 minutes. He weighs 70 kg. What else must be done today?

After the vaginal delivery of an Rh D-positive baby to an Rh D-negative mother whose indirect Coombs test has been negative throughout pregnancy, what is the correct anti-D prophylaxis?

Statements about raloxifene used in a postmenopausal woman with osteoporosis: 1. It reduces vertebral fractures. 2. It causes endometrial hyperplasia. 3. It increases the risk of venous thromboembolism. 4. It lowers the risk of invasive oestrogen receptor-positive breast cancer. Which are true?