What is the most common primary malignancy of the fallopian tube?
Which contraceptive method has the lowest pregnancy failure rate (typical use)?
Decidual reaction is due to which hormone?
Palmer sign is related to ?
What is the treatment for uterine prolapse in nulliparous women?
Which of the following is a recognized method for the delivery of the after-coming head of a breech?
Which of the following statements about cholestasis of pregnancy is false?
Gold standard technique for diagnosis of endometriosis?
In which scenario is the I-pill (emergency contraceptive) most appropriately used?
What is the treatment of choice for Bartholin's cyst?
NEET-PG 2012 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 11: What is the most common primary malignancy of the fallopian tube?
- A. Squamous cell carcinoma
- B. Serous carcinoma (Correct Answer)
- C. Teratoma
- D. Choriocarcinoma
Explanation: ***Serous carcinoma*** - **Serous carcinoma** is the most common type of **primary** fallopian tube malignancy, accounting for approximately **90%** of primary tumors. - It often shares molecular and morphological similarities with **high-grade serous ovarian carcinoma** and **primary peritoneal cancer**. - Note: While primary fallopian tube cancer is rare (0.14-1.8% of gynecologic malignancies), metastatic disease to the fallopian tube is more common, typically from **ovarian or endometrial** primaries. *Squamous cell carcinoma* - **Squamous cell carcinoma** is exceedingly rare in the fallopian tube, as the tubal lining is composed of **ciliated and secretory columnar epithelium**, not squamous epithelium. - When present, it usually represents **metastatic spread** from cervical or other primary sites. *Teratoma* - **Teratomas** are germ cell tumors typically found in the **ovaries**, composed of tissues from multiple germ layers. - Primary teratomas of the fallopian tube are **extraordinarily rare** and not the most common primary malignancy. *Choriocarcinoma* - **Choriocarcinoma** is a highly malignant **gestational trophoblastic neoplasm** usually associated with pregnancy complications. - It primarily occurs in the **uterus**, and primary fallopian tube choriocarcinoma is **exceptionally uncommon**.
Question 12: Which contraceptive method has the lowest pregnancy failure rate (typical use)?
- A. Diaphragm
- B. Condom
- C. Intrauterine Contraceptive Device (IUCD) (Correct Answer)
- D. Oral Contraceptive Pills (OCP)
Explanation: ***Intrauterine Contraceptive Device (IUCD)*** - **IUCDs** are highly effective, with a **pregnancy failure rate of less than 1%** in typical use due to their long-acting and reversible nature, requiring no daily action from the user. - They are **fit-and-forget methods**, eliminating user error inherent in other forms of contraception, leading to very low typical use failure rates. *Diaphragm* - The **diaphragm** has a significantly higher typical use failure rate (around 12-16%) because its effectiveness depends on **correct placement** and consistent use with spermicide before each intercourse. - It is a **user-dependent method**, making its efficacy susceptible to improper use or non-use during sexual activity. *Condom* - **Condoms** have a typical use failure rate of about 13-18%, largely due to **incorrect use**, breakage, or slippage. - Their effectiveness relies heavily on **consistent and proper application** with every act of intercourse. *Oral Contraceptive Pills (OCP)* - **Oral Contraceptive Pills (OCPs)** have a typical use failure rate of approximately 7-9%, primarily because effectiveness is dependent on **daily adherence** at roughly the same time. - **Missed pills** are a common reason for failure, significantly increasing the risk of pregnancy compared to methods that do not require daily action.
Question 13: Decidual reaction is due to which hormone?
- A. Progesterone (Correct Answer)
- B. Estrogen
- C. LH
- D. FSH
Explanation: ***Progesterone*** - The **decidual reaction** is a specific uterine stromal cell differentiation process that prepares the endometrium for **implantation and pregnancy maintenance**. - This process is primarily induced and maintained by **progesterone**, which causes stromal cells to enlarge, accumulate glycogen and lipids, and secrete various factors essential for embryonic development. *Estrogen* - Estrogen plays a crucial role in the **proliferation of the endometrium** during the follicular phase, building up the uterine lining. - While estrogen is essential, it acts in conjunction with progesterone; progesterone is the **primary hormone** responsible for the decidualization process itself. *LH* - Luteinizing hormone (LH) is responsible for triggering **ovulation** and stimulating the corpus luteum to produce progesterone. - LH's direct role is not in the decidual reaction of the endometrium but rather in the **ovarian events** that lead to the production of the hormones that cause decidualization. *FSH* - Follicle-stimulating hormone (FSH) is vital for the growth and maturation of **ovarian follicles** and **estrogen production**. - FSH does not directly induce the decidual reaction but facilitates the production of estrogen, which then contributes to endometrial proliferation, a precursor to progesterone's decidualizing effect.
Question 14: Palmer sign is related to ?
- A. Increased pulsations in uterine arteries
- B. Bluish discoloration of cervix and vagina
- C. Softening of the cervix during pregnancy
- D. Uterine contractions palpable through rectum during labor (Correct Answer)
Explanation: ***Uterine contractions palpable through rectum during labor*** - **Palmer sign** refers to the palpation of **uterine contractions** through the rectum, particularly during the early stages of labor or even in simulated labor pains. - This sign is an indicator used to assess uterine activity, especially when vaginal examination might be less informative or desired. *Softening of the cervix during pregnancy* - This describes **Goodell's sign**, which is caused by increased vascularity and edema of the cervix during early pregnancy. - While an important sign of pregnancy, it is not referred to as Palmer sign. *Bluish discoloration of cervix and vagina* - This phenomenon is known as **Chadwick's sign**, resulting from increased blood flow to the reproductive organs during pregnancy. - It is an early indication of pregnancy but distinct from the uterine contraction palpation. *Increased pulsations in uterine arteries* - This is known as **Osiander’s sign** or **uterine souffle**, characterized by a soft blowing sound over the uterus due to increased blood flow through the uterine arteries. - It is a vascular sign of pregnancy and not related to uterine contractions felt rectally.
Question 15: What is the treatment for uterine prolapse in nulliparous women?
- A. Anterior colporrhaphy
- B. Posterior colporrhaphy
- C. Sling used involving rectus sheath
- D. Manchester operation (Correct Answer)
Explanation: ***Manchester operation*** - This procedure is sometimes considered for **nulliparous women** with uterine prolapse, particularly if combined with cervical elongation. - It involves **amputation of the cervix** and support of the cardinal ligaments, which can address the prolapse while preserving uterine function. *Sling used involving rectus sheath* - A sling using the rectus sheath is typically employed for **stress urinary incontinence**, not primarily for uterine prolapse. - While it supports the urethra and bladder neck, it does not directly address the descent of the uterus. *Anterior colporrhaphy* - This procedure repairs a **cystocele** (prolapse of the bladder into the vagina) by tightening the anterior vaginal wall. - It does not directly manage **uterine prolapse** itself, though a cystocele can coexist with uterine descent. *Posterior colporrhaphy* - This surgical repair targets a **rectocele** (prolapse of the rectum into the vagina) by tightening the posterior vaginal wall. - Similar to anterior colporrhaphy, it addresses a specific vaginal wall defect rather than the **uterine position**.
Question 16: Which of the following is a recognized method for the delivery of the after-coming head of a breech?
- A. Burns and Marshall method
- B. Malar flexion and shoulder traction
- C. Forceps method
- D. Mauriceau-Smellie-Veit maneuver (Correct Answer)
Explanation: ***Mauriceau-Smellie-Veit maneuver*** - The **Mauriceau-Smellie-Veit maneuver** is the **gold standard** and most widely recognized method for delivering the after-coming head in breech delivery. - The technique involves the accoucheur placing the **index and middle fingers over the maxilla** (malar eminence) to flex the fetal head, while the fetal body rests on the forearm. - An assistant applies **suprapubic pressure** to maintain flexion of the fetal head. - This method provides excellent **control of the fetal head** and maintains proper flexion to prevent extension and facilitate safe delivery. *Burns and Marshall method* - The **Burns-Marshall method** is also a recognized technique for assisted breech delivery, but it is typically used when the body delivers spontaneously. - This method involves holding the fetal feet and allowing the baby to hang by its own weight, promoting flexion, then sweeping the baby upward over the maternal abdomen. - While valid, it is generally considered an **alternative** to the Mauriceau-Smellie-Veit maneuver rather than the primary method. *Forceps method* - **Piper forceps** are specifically designed for the after-coming head and are a recognized method, particularly when manual methods fail or in cases of **fetal distress**. - However, forceps application requires specific expertise and may not be the first-line approach in all settings. - When used appropriately, forceps provide controlled delivery and protect the fetal head. *Malar flexion and shoulder traction* - This is **not a recognized standard method** as described. - While malar pressure is used in the Mauriceau-Smellie-Veit maneuver, **shoulder traction** is dangerous and can cause **brachial plexus injury**, **Erb's palsy**, or **spinal cord damage**. - Traction should never be applied to the shoulders during breech delivery.
Question 17: Which of the following statements about cholestasis of pregnancy is false?
- A. Bilirubin level >2mg%
- B. Most common cause of jaundice in pregnancy (Correct Answer)
- C. Oestrogen is involved
- D. Manifestations usually appear in last trimester
Explanation: ***Most common cause of jaundice in pregnancy*** - This statement is **FALSE** - while **intrahepatic cholestasis of pregnancy (ICP)** is the most common **pregnancy-specific** cause of jaundice, it is NOT the most common cause of jaundice overall in pregnancy. - **Viral hepatitis** (especially hepatitis A, B, and E) remains the **most common cause of jaundice in pregnancy** worldwide, accounting for approximately 40-50% of cases. - ICP accounts for about 20-25% of jaundice cases in pregnancy, making it the leading obstetric-specific cause but not the overall leading cause. *Bilirubin level >2mg%* - In ICP, **bilirubin levels** are typically **normal or only mildly elevated** (usually <4 mg/dL, often <2 mg/dL). - However, bilirubin **can exceed 2 mg/dL** in some cases of ICP, particularly in more severe presentations. - The primary diagnostic marker is elevated **serum bile acids** (>10 μmol/L), not bilirubin. *Oestrogen is involved* - **TRUE** - Elevated **estrogen and progesterone levels** during pregnancy play a key role in ICP pathophysiology. - These hormones affect **hepatic bile salt transporters** (particularly BSEP and MDR3), leading to impaired bile secretion in genetically susceptible individuals. *Manifestations usually appear in last trimester* - **TRUE** - ICP typically presents in the **third trimester** (usually after 28 weeks), with **pruritus** as the predominant symptom. - Symptoms resolve within days to weeks after delivery, correlating with declining hormone levels.
Question 18: Gold standard technique for diagnosis of endometriosis?
- A. Ca 125 level
- B. Ultrasound
- C. MRI
- D. Laparoscopy (Correct Answer)
Explanation: ***Laparoscopy*** - **Laparoscopy** allows for direct visualization of endometrial implants and enables **biopsy confirmation**, making it the gold standard. - This minimally invasive surgical procedure is crucial for diagnosing, staging, and often treating endometriosis simultaneously. *Ca 125 level* - **CA-125** is a serum marker that can be elevated in endometriosis, but it is **not specific** and can be raised in other conditions like ovarian cancer or physiologic states. - It is primarily used for monitoring treatment response or recurrence, rather than as a primary diagnostic tool. *Ultrasound* - **Transvaginal ultrasound (TVS)** can identify endometriomas (chocolate cysts) and deep infiltrating endometriosis, but it cannot reliably visualize small peritoneal implants. - While it's a good initial imaging modality, its sensitivity for diagnosing all forms of endometriosis is **limited**. *MRI* - **MRI** offers better soft tissue contrast than ultrasound and can identify deep infiltrating endometriosis and some peritoneal implants, especially those involving the bowel or bladder. - However, MRI is **more expensive** and less accessible, and it still cannot definitively rule out all small, superficial endometrial lesions without direct visualization.
Question 19: In which scenario is the I-pill (emergency contraceptive) most appropriately used?
- A. When a contraceptive method fails
- B. After unprotected sexual intercourse
- C. As a regular contraceptive method
- D. In case of contraceptive failure or unprotected sex (Correct Answer)
Explanation: ***In case of contraceptive failure or unprotected sex*** - This is the **most comprehensive and appropriate answer** as it covers **both major indications** for emergency contraception. - The **I-pill (levonorgestrel)** is indicated when there has been unprotected intercourse OR when a contraceptive method has failed (e.g., condom breakage, missed pills, dislodged IUD). - It should be taken as soon as possible, ideally within **72 hours** of the event, though it can be used up to 120 hours with reduced efficacy. - This option correctly encompasses the full scope of emergency contraception use. *After unprotected sexual intercourse* - While this is a **valid indication**, it only covers one scenario and is not as comprehensive as the correct answer. - This option misses situations of contraceptive failure where intercourse was technically "protected" but the method failed. *When a contraceptive method fails* - This is also a **valid indication** but only covers contraceptive accidents (condom breakage, missed pills). - It excludes situations where no contraceptive was used at all. - Like the previous option, it is incomplete compared to the correct answer. *As a regular contraceptive method* - The I-pill is **not intended for routine contraception** due to higher hormone doses and lower efficacy compared to regular methods. - It has a higher side effect profile with frequent use and does not protect against sexually transmitted infections. - Emergency contraception should only be used occasionally in emergency situations.
Question 20: What is the treatment of choice for Bartholin's cyst?
- A. Excision
- B. Antibiotic therapy
- C. Marsupialization (Correct Answer)
- D. Cyst drainage
Explanation: ***Marsupialization*** - This procedure involves incising the cyst, draining its contents, and then everting and suturing the edges of the cyst wall to the surrounding skin, creating a permanent-draining pouch. - **Marsupialization** is the treatment of choice because it prevents recurrence by allowing continuous drainage of mucus, unlike simple incision and drainage. *Excision* - Complete surgical excision of the Bartholin's gland or cyst is a more invasive procedure and is typically reserved for cases of **recurrent cysts** after marsupialization or suspected malignancy. - It carries a higher risk of bleeding and infection compared to marsupialization, and can lead to **vaginal dryness** due to loss of glandular secretions. *Antibiotic therapy* - Antibiotics are primarily used if the Bartholin's gland becomes **infected**, leading to an **abscess**, or if there is surrounding cellulitis. - They do not address the underlying blockage of the duct and will not resolve a Bartholin's cyst, which is a collection of mucus due to duct obstruction. *Cyst drainage* - Simple incision and drainage (I&D) provides temporary relief by emptying the cyst contents but has a **high recurrence rate** because the duct often re-occludes. - While it may be used as an initial temporizing measure, it is not the definitive treatment for preventing future episodes of Bartholin's cysts.