Which of the following statements about Hegar's sign is false?
In a 5-month pregnant female, which of the following statements regarding physiological changes is true?
What is the best method to diagnose an unruptured ectopic pregnancy?
What is the initial drug of choice for ovarian cancer?
Preferred treatment for menorrhagia in reproductive age group?
Which condition is associated with exclusively fetal blood loss?
In which gestational weeks is Hegar's sign typically observed?
Newborn can be given breast milk after how much time following normal delivery?
The optimal timing for external cephalic version (ECV) is
What is the presenting part in a transverse lie?
NEET-PG 2012 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 31: Which of the following statements about Hegar's sign is false?
- A. Bimanual palpation method
- B. Present in 2/3rd of cases (Correct Answer)
- C. Difficult in obese
- D. Can be done at 14 weeks
Explanation: ***Present in 2/3rd of cases*** - This statement is **FALSE** and is the correct answer to this question. - Hegar's sign, while a classic sign of pregnancy, is not consistently present in 2/3rds of cases with such statistical certainty. - Its detectability varies significantly depending on **gestational age** (optimal 6-12 weeks), **uterine position** (retroverted uterus makes it harder), **examiner experience**, and **patient body habitus**. - This specific "2/3rd" frequency claim lacks strong evidence-based support in obstetric literature. *Bimanual palpation method* - This statement is TRUE. - **Hegar's sign** is elicited by **bimanual pelvic examination** where one hand is placed on the abdomen and the other in the vagina to palpate the softening and compressibility of the **lower uterine segment** (isthmus). - The examiner feels the cervix and uterine fundus separately with the soft isthmus compressed between the examining fingers. *Difficult in obese* - This statement is TRUE. - **Obesity** makes any deep abdominal or pelvic palpation more challenging due to increased adipose tissue. - The **softening of the lower uterine segment** is harder to appreciate, reducing the sensitivity of detecting Hegar's sign in obese patients. *Can be done at 14 weeks* - This statement is technically TRUE but represents suboptimal timing. - **Hegar's sign** is most reliably detectable between the **6th and 12th weeks of gestation**. - At **14 weeks**, while the examination can still be performed, the uterus has grown significantly and risen into the abdomen, making the lower uterine segment less compressible and the sign much less prominent or absent. - The statement doesn't claim it's "optimal" at 14 weeks, only that it "can be done," which is technically accurate even if clinically impractical.
Question 32: In a 5-month pregnant female, which of the following statements regarding physiological changes is true?
- A. Cardiac output is reduced
- B. Systemic vascular resistance is increased
- C. Increase in CVP
- D. 80-90% have soft systolic murmur (Correct Answer)
Explanation: ***80-90% have soft systolic murmur*** - The **increased blood volume** and **cardiac output** during pregnancy lead to increased flow across the aortic and pulmonic valves, often resulting in a **physiological systolic ejection murmur**. - This murmur is typically heard best at the **left sternal border** and usually resolves after delivery. *Cardiac output is reduced* - **Cardiac output actually increases** significantly during pregnancy, typically by 30-50%, to meet the metabolic demands of the fetus and placenta. - This increase is due to both an **increase in heart rate** and **stroke volume**. *Systemic vascular resistance is increased* - **Systemic vascular resistance (SVR) decreases** during pregnancy, primarily due to the **vasodilating effects of progesterone** and the creation of a **low-resistance placental circulation**. - The drop in SVR contributes to the physiological **decrease in blood pressure** often observed in mid-pregnancy. *Increase in CVP* - **Central venous pressure (CVP) typically remains unchanged or slightly decreases** during normal pregnancy. - While blood volume increases, the accompanying **vasodilation and decreased SVR** usually prevent a significant rise in CVP.
Question 33: What is the best method to diagnose an unruptured ectopic pregnancy?
- A. Endoscopy
- B. UPT
- C. USG (Correct Answer)
- D. Culdocentesis
Explanation: ***Correct Answer: USG*** - **Transvaginal ultrasound (TVS)** is the most common and effective method for diagnosing an unruptured ectopic pregnancy. It allows for visualization of a gestational sac outside the uterus or an adnexal mass. - In conjunction with **serum beta-hCG levels**, TVS helps to differentiate between an intrauterine pregnancy and an ectopic pregnancy, especially when hCG levels are above the discriminatory zone (typically 1500-2000 mIU/mL). - TVS has high sensitivity and specificity for detecting ectopic pregnancy and is **non-invasive**. *Incorrect: Endoscopy* - **Endoscopy** (such as laparoscopy) is a surgical procedure, primarily used for direct visualization and treatment of ectopic pregnancies, not for initial diagnosis. - It is *too invasive* for routine diagnostic purposes in an unruptured ectopic pregnancy. *Incorrect: UPT* - A **urine pregnancy test (UPT)** confirms pregnancy but *cannot determine the location* of the pregnancy. - A positive UPT only indicates the presence of **hCG**, which is elevated in both intrauterine and ectopic pregnancies. *Incorrect: Culdocentesis* - **Culdocentesis** involves aspirating fluid from the cul-de-sac and is used to detect the presence of *free blood* in the peritoneal cavity, indicating a **ruptured** ectopic pregnancy. - It is not useful for diagnosing an **unruptured ectopic pregnancy** and is largely replaced by ultrasound in modern practice.
Question 34: What is the initial drug of choice for ovarian cancer?
- A. Cisplatin (Correct Answer)
- B. Doxorubicin
- C. Ifosfamide
- D. Methotrexate
Explanation: ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms DNA adducts, leading to apoptosis and is a **first-line agent** for ovarian cancer. - Historically, it was the platinum agent of choice and is typically used in combination with a taxane (e.g., **paclitaxel**) for initial treatment of advanced disease. - **Note:** In current practice, **carboplatin** has largely replaced cisplatin as the preferred platinum agent due to better tolerability, less nephrotoxicity and neurotoxicity, and easier administration, while maintaining equivalent efficacy. - Among the options listed, **cisplatin remains the correct answer** as it is the only platinum-based first-line agent. *Doxorubicin* - **Doxorubicin** is an **anthracycline antibiotic** used in various cancers but is **not a first-line drug** for ovarian cancer. - It may be used in recurrent or platinum-resistant disease. - Its use is limited due to potential **cardiotoxicity**. *Ifosfamide* - **Ifosfamide** is an **alkylating agent** that is generally reserved for **recurrent** or refractory ovarian cancer. - It is associated with **hemorrhagic cystitis** (preventable with mesna) and neurotoxicity. - Not part of standard first-line treatment. *Methotrexate* - **Methotrexate** is an **antimetabolite** primarily used in other cancers like choriocarcinoma and is **not a standard treatment** for epithelial ovarian cancer. - It works by inhibiting dihydrofolate reductase, disrupting DNA synthesis. - Has no role in first-line ovarian cancer treatment.
Question 35: Preferred treatment for menorrhagia in reproductive age group?
- A. Cu IUD
- B. Hysterectomy
- C. NOVA T
- D. OCPs (Correct Answer)
Explanation: ***OCPs*** - **Combined oral contraceptives (OCPs)** are a common and effective first-line treatment for menorrhagia in reproductive-aged women, particularly when contraception is also desired. - They work by stabilizing the **endometrial lining**, reducing menstrual blood loss and regulating cycles. *NOVA T* - NOVA T is a type of **copper IUD (intrauterine device)**, which is known to potentially *increase* menstrual bleeding and dysmenorrhea, making it unsuitable for menorrhagia. - Its primary function is contraception, not the management of heavy menstrual bleeding. *Cu IUD* - The **copper intrauterine device (Cu IUD)** is generally contraindicated in women with menorrhagia because it can exacerbate heavy menstrual bleeding. - While an effective contraceptive, it does not offer therapeutic benefits for managing heavy periods. *Hysterectomy* - **Hysterectomy** is a surgical procedure for removing the uterus and is considered a definitive treatment for menorrhagia. - However, it is an **invasive procedure** with irreversible loss of fertility, typically reserved for severe cases where conservative treatments have failed or when other uterine pathology is present.
Question 36: Which condition is associated with exclusively fetal blood loss?
- A. Vasa previa (Correct Answer)
- B. Placenta praevia
- C. Polyhydramnios
- D. Oligohydramnios
Explanation: ***Vasa previa*** - Vasa previa occurs when **fetal blood vessels** from the umbilical cord traverse the membranes over the cervical os, underneath the fetal presenting part. - Rupture of these unprotected vessels, which can happen during labor or membrane rupture, leads to **exclusively fetal blood loss**, posing a high risk of fetal exsanguination and death. *Placenta praevia* - This condition involves the **placenta implanting low** in the uterus, potentially covering the internal cervical os. - Bleeding in placenta previa is typically **maternal** in origin, resulting from the detachment of the placenta from the uterine wall as the cervix dilates. *Polyhydramnios* - Polyhydramnios is characterized by an **excessive amount of amniotic fluid**. - It is not directly associated with antepartum or intrapartum bleeding, but rather with conditions that affect fetal swallowing or urination, such as **fetal gastrointestinal anomalies** or maternal diabetes. *Oligohydramnios* - Oligohydramnios refers to an **insufficient amount of amniotic fluid**. - While it can be associated with various fetal and maternal complications, such as **renal agenesis** or premature rupture of membranes, it does not typically cause blood loss.
Question 37: In which gestational weeks is Hegar's sign typically observed?
- A. 10-14 weeks
- B. 14-18 weeks
- C. 18-22 weeks
- D. 6 to 10 weeks (Correct Answer)
Explanation: ***6 to 10 weeks*** - **Hegar's sign** is a softening of the lower uterine segment, which is a probable sign of pregnancy detected during a **bimanual examination**. - This softening typically becomes noticeable and palpable between **6 and 10 weeks of gestation** due to increased vascularity and edema in the area. *10-14 weeks* - While the uterus continues to soften and enlarge, **Hegar's sign** is usually established earlier, making it less specific or prominent for confirmation in this later window. - At this stage, other signs of pregnancy, such as a **palpable fetal outline** or **fetal heart tones**, become more readily apparent. *14-18 weeks* - By this gestational period, the uterus is significantly larger and has risen out of the pelvic cavity, making the specific assessment of the **lower uterine segment's compressibility** as an isolated sign less relevant. - **Fetal movements** (quickening) may also be felt during this time, serving as a more direct indicator of pregnancy. *18-22 weeks* - At these later weeks, the uterus is distinctly enlarged, and much of the diagnosis relies on **fundal height assessment** and further monitoring of fetal development. - **Hegar's sign** is a very early sign of pregnancy and would not be used for confirmation in this advanced stage.
Question 38: Newborn can be given breast milk after how much time following normal delivery?
- A. Half hour
- B. 2 hours
- C. 1 hour (Correct Answer)
- D. 3 hours
Explanation: ***1 hour*** - Initiating breastfeeding **within 1 hour** after a normal vaginal delivery is the **WHO and UNICEF recommended standard** for optimal newborn care. - This practice, often called the **"golden hour"**, allows the newborn to benefit from **colostrum** (rich in antibodies and nutrients), promotes **mother-infant bonding**, and helps stimulate **uterine contractions** to reduce postpartum hemorrhage. - Early initiation within this timeframe supports **successful establishment of breastfeeding** and improves exclusive breastfeeding rates. *Half hour* - While initiating breastfeeding within 30 minutes is **excellent and encouraged**, the standard guideline allows up to 1 hour. - Immediate or very early feeding (within 30 minutes) is ideal when mother and baby are stable, but the flexibility up to 1 hour accommodates immediate postpartum care needs. *2 hours* - Delaying breastfeeding until 2 hours post-delivery **exceeds the recommended window** and can lead to the infant becoming **less alert** and less interested in feeding. - This delay is associated with **lower rates of successful exclusive breastfeeding** and may impact milk supply establishment. *3 hours* - A 3-hour delay in initiating breastfeeding is **significantly beyond recommended guidelines** after a normal, uncomplicated delivery. - Such delays can contribute to **poor latch**, **infant fatigue**, increased **formula supplementation**, and may hinder **long-term breastfeeding success**.
Question 39: The optimal timing for external cephalic version (ECV) is
- A. 34 weeks
- B. 36 weeks (Correct Answer)
- C. 38 weeks
- D. 40 weeks
Explanation: ***36 weeks*** - At **36 weeks gestation**, there is still enough **amniotic fluid** and fetal size is not too large, which allows for successful manipulation. - This timing is particularly optimal for **multiparous women** according to **RCOG guidelines** (36-37 weeks). - This timing also minimizes the risk of **spontaneous reversion** back to a breech presentation before labor begins. - Balances adequate fetal maturity with sufficient uterine space for successful version. *34 weeks* - Performing an external cephalic version (ECV) at 34 weeks has a lower success rate and a higher chance of **spontaneous reversion** due to the smaller fetal size and relatively more amniotic fluid. - The chance of **spontaneous cephalic version** (natural turning) is still significant at this stage, making an earlier intervention potentially unnecessary. - Too early for routine ECV as many breech presentations spontaneously convert to cephalic before 36 weeks. *38 weeks* - By 38 weeks, the fetus is larger and there is proportionally less **amniotic fluid**, which makes successful external version more difficult and painful for the mother. - While **ACOG recommends 37-38 weeks**, the success rate decreases with advancing gestation due to reduced uterine space. - The risk of **uterine contractions** and iatrogenic induction of labor is higher at this gestation. *40 weeks* - At 40 weeks, the fetus is at term and much larger, occupying most of the uterine cavity, significantly reducing the chances of a successful external version. - The risk of complications such as **placental abruption**, **cord compression**, and premature labor is increased. - Success rates are markedly lower, making routine ECV at this stage generally not recommended.
Question 40: What is the presenting part in a transverse lie?
- A. Shoulder (Correct Answer)
- B. Face
- C. Vertex
- D. Brow
Explanation: ***Shoulder*** - In a **transverse lie**, the fetal **shoulder** is the part that presents over the pelvic inlet. - This occurs when the fetal long axis is 90 degrees to the maternal spine. *Face* - A **face presentation** is a type of **cephalic presentation** where the head is hyperextended, and the face is the presenting part. - This is not characteristic of a transverse lie. *Vertex* - A **vertex presentation** is the most common and ideal **cephalic presentation**, where the head is flexed and the top of the head (vertex) is the presenting part. - This indicates a longitudinal lie, not a transverse lie. *Brow* - A **brow presentation** is also a type of **cephalic presentation** where the fetal head is partially extended, and the brow is the presenting part. - Like vertex and face presentations, this occurs with a longitudinal fetal lie.