NEET-PG 2012 - Obstetrics and Gynecology Practice Questions

Q: Which of the following pelvic measurements is most commonly used in clinical practice?

Diagonal conjugate. ***Diagonal conjugate*** - This measurement is the most commonly used in clinical practice due to its **accessibility** and ability to estimate the **obstetrical conjugate**, which indicates the true AP diameter of the pelvic inlet. - It is measured vaginally from the **lower border of the symphysis pubis** to the **sacral promontory**. *Anteroposterior diameter of inlet* - This measurement, also known as the **obstetrical conjugate**, truly represents the narrowest AP diameter for fetal passage through the inlet. - However, it cannot be measured directly clinically and must be estimated from the diagonal conjugate or imaging. *Transverse diameter of outlet* - This measurement is important for assessing the **midpelvis** and **pelvic outlet**, but it is less commonly the primary measurement used for initial pelvic assessment compared to the diagonal conjugate. - A compromised transverse diameter can indicate a generally contracted pelvis or **android/anthropoid pelvic shapes**, which may lead to obstructed labor. *Oblique diameter of pelvis* - The oblique diameter provides information about the **symmetry of the pelvis**, but it is not routinely measured clinically unless there is suspicion of pelvic asymmetry or disease. - Significant asymmetry, often due to injury or disease (e.g., **scoliosis**, polio), can complicate labor by misdirecting the fetal head.

Q: After delivery upto which week is known as puerperium?

6 weeks. ***6 weeks*** - The **puerperium** is the period of approximately **6 weeks** after childbirth during which the mother's body undergoes physiological adaptations to return to its non-pregnant state. - This timeframe allows for the involution of the uterus and the restoration of reproductive organs and systemic physiology. *2 weeks* - This period is too short to encompass the full physiological recovery process after childbirth. - While immediate postpartum changes occur, many maternal systems, such as the reproductive organs, have not fully reverted to their pre-pregnancy state within 2 weeks. *4 weeks* - This duration is still considered an incomplete period for the extensive physiological changes that define the puerperium. - Uterine involution often continues beyond 4 weeks, and other hormonal and systemic adjustments are still ongoing. *8 weeks* - While recovery continues, the primary definition of the puerperium typically concludes at **6 weeks postpartum**. - By 8 weeks, most significant physiological changes have already occurred, and the body is largely back to its pre-pregnant state.

Q: What is the most common complication that can arise from vacuum delivery during childbirth?

Cephalohematoma. ***Cephalohematoma*** - A cephalohematoma is a collection of blood between the **periosteum and the skull bone**, typically forming over the parietal bone. - It is the **most common complication** of vacuum delivery, occurring in **6-26% of vacuum-assisted deliveries**. - It presents as a firm, fluctuant swelling that **does not cross suture lines** and typically appears several hours after delivery. - Usually **self-limiting** and resolves spontaneously over weeks to months, though it may be associated with hyperbilirubinemia. *Subgaleal hemorrhage* - This is a more serious but **less common** complication (0.4-0.6% incidence) involving bleeding into the **potential space between the galea aponeurotica and the periosteum**. - Can lead to significant blood loss and hypovolemic shock due to the large potential space that can accommodate substantial blood volume. - Requires immediate recognition and management, but its lower incidence makes it less common than cephalohematoma. *Scalp lacerations* - Occur in approximately **13% of vacuum deliveries** but are less common than cephalohematoma. - Typically superficial and heal well with minimal intervention. - Result from the rim of the vacuum cup causing trauma to the scalp tissue. *Retinal hemorrhages* - Occur in up to **40-50% of all vaginal deliveries** (both spontaneous and assisted), making them common but not specific to vacuum delivery. - Usually **asymptomatic and self-limiting**, resolving within days to weeks without sequelae. - While common, cephalohematoma remains the most frequently documented **specific complication** of vacuum extraction.

Q: 35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?

Premature ovarian failure. ***Premature ovarian failure*** - The combination of **amenorrhea** for 4 months in a 35-year-old, with **increased FSH** and **decreased estrogen**, is characteristic of premature ovarian failure, indicating the ovaries are no longer responding to FSH stimulation. - This condition signifies the cessation of ovarian function before the age of 40, leading to menopausal symptoms and infertility. *Pituitary dysfunction* - Pituitary dysfunction might lead to **decreased FSH** (hypogonadotropic hypogonadism) due to insufficient stimulation of the ovaries, not increased FSH. - In cases of pituitary adenomas, increased prolactin can cause amenorrhea, but FSH would not be elevated in the manner described. *Hypothalamic dysfunction* - Hypothalamic dysfunction, such as **functional hypothalamic amenorrhea**, typically presents with **low or normal FSH and LH levels** (hypogonadotropic hypogonadism) due to reduced GnRH pulsatility. - This condition is often associated with stress, excessive exercise, or low body weight, and would not cause elevated FSH as seen here. *Polycystic Ovary Syndrome* - **Polycystic Ovary Syndrome (PCOS)** is characterized by **anovulation**, resulting in amenorrhea or oligomenorrhea, but typically involves **elevated androgens** and a **high LH-to-FSH ratio**, with FSH levels generally normal or low, and estrogen levels often normal or slightly elevated. - It would not present with simultaneously high FSH and low estrogen, which points to ovarian failure rather than anovulation with intact ovarian reserve.

Q: What is the definitive management for adenomyosis?

Hysterectomy (surgical removal of the uterus).. ***Hysterectomy (surgical removal of the uterus)*** - This is considered the **definitive management** for adenomyosis because it completely removes the uterine tissue where the ectopic endometrial glands are found. - Hysterectomy effectively eliminates the source of symptoms such as **heavy menstrual bleeding** and **pelvic pain** by removing the uterus entirely. *Endometrial ablation* - Endometrial ablation involves destroying the **lining of the uterus** and is primarily used for heavy menstrual bleeding. - It is **ineffective for adenomyosis** since the endometrial tissue is embedded deep within the myometrium and is not fully reached by ablation. *Hormonal therapy (e.g., Danazol) for temporary symptom relief* - **Danazol** (an androgen derivative) can suppress ovarian function and reduce symptoms of adenomyosis by shrinking endometrial tissue. - However, its effects are **temporary**, and symptoms typically return upon cessation of treatment, making it not a definitive solution. *Hormonal therapy (e.g., GNRH analogue) for temporary symptom relief* - **GnRH analogues** induce a temporary menopausal state, which can significantly reduce symptoms by inhibiting estrogen production, leading to atrophy of the adenomyotic tissue. - This treatment is also **temporary**, and symptoms often recur once the medication is stopped; it's often used as a bridge to surgery or for women nearing menopause.

Q: Spinnbarkeit is maximum shown at which phase?

Ovulatory. ***Ovulatory*** - **Spinnbarkeit** refers to the stringy, stretchy quality of cervical mucus, which is maximal during the ovulatory phase due to high **estrogen levels**. - This highly elastic mucus facilitates **sperm transport** to the uterus and fallopian tubes for fertilization. *Menstrual phase* - During the menstrual phase, **cervical mucus** is typically minimal and sticky, making it unfavorable for sperm survival. - This phase is characterized by low estrogen and progesterone levels, leading to the **shedding of the uterine lining**. *Post ovulatory* - After ovulation, under the influence of **progesterone**, cervical mucus becomes thick, sticky, and opaque, decreasing **spinnbarkeit**. - This change in mucus consistency forms a **barrier to sperm penetration** into the uterus. *Follicular phase* - In the early follicular phase, **estrogen levels** are low, resulting in thick, scanty, and opaque cervical mucus with low **spinnbarkeit**. - As the follicular phase progresses and estrogen levels rise, the mucus gradually becomes more **watery and elastic**, but it doesn't reach its peak stretchiness until ovulation.

Q: In a severely anaemic pregnant patient presenting with cardiac failure, what is the most appropriate choice of transfusion?

Exchange transfusion. ***Exchange transfusion*** - In **severe anaemia with cardiac failure**, exchange transfusion simultaneously **removes** and **replaces** blood volume, correcting anaemia without **net volume increase** that could worsen cardiac failure. - This procedure is the **safest option** as it avoids **fluid overload** while effectively improving **oxygen-carrying capacity** in cardiac-compromised pregnant patients. *Platelets* - **Platelets** are indicated for **thrombocytopenia** or **platelet dysfunction** to prevent bleeding, not for correcting anaemia. - They provide no benefit for **oxygen transport** or the underlying cause of cardiac failure in this anaemic patient. *Packed cells* - **Packed red blood cells** still add **net volume** to circulation, which can precipitate **pulmonary edema** and worsen cardiac failure despite slower infusion. - Even with **diuretics**, the risk of **fluid overload** remains significant in patients with pre-existing cardiac compromise. *Whole blood* - **Whole blood** contains **plasma volume** that significantly increases circulatory load, making it particularly dangerous in cardiac failure. - The large **volume expansion** can rapidly lead to **congestive heart failure** and **pulmonary edema** in already compromised patients.

Q: What is the most common cause of hydrops fetalis in current medical practice?

Cardiac malformations. ***Cardiac malformations*** - **Cardiovascular abnormalities** are the **most common cause** of **non-immune hydrops fetalis** in current medical practice, accounting for **20-40%** of cases - Includes **structural heart defects** (septal defects, valvular abnormalities) and **arrhythmias** (supraventricular tachycardia, complete heart block) - These conditions lead to **heart failure** and **increased hydrostatic pressure**, causing fluid accumulation in fetal tissues and body cavities - With the near-elimination of Rh disease through immunoprophylaxis, cardiac causes have emerged as the leading etiology *Chromosomal abnormalities* - Account for **10-20%** of non-immune hydrops cases - **Turner syndrome (45,X)** is the most common chromosomal cause, associated with **cystic hygroma** and **lymphatic dysgenesis** - Other chromosomal conditions include **trisomy 21, 18, and 13**, which can cause hydrops through associated cardiac defects or other mechanisms - While significant, chromosomal causes are less common than cardiovascular causes overall *Fetal infections (e.g., parvovirus B19)* - Infections account for **5-10%** of non-immune hydrops cases - **Parvovirus B19** is the most common infectious cause, leading to severe **fetal anemia** through bone marrow suppression - Other infectious agents include **CMV**, **toxoplasmosis**, and **syphilis** - The TORCH screening helps identify treatable infectious causes *Rh incompatibility (historically significant)* - Historically the **leading cause** before the 1970s, accounting for most hydrops cases - Now accounts for **<10%** of cases due to routine **Rho(D) immune globulin (RhoGAM)** administration at 28 weeks and postpartum - Causes **immune hydrops** through maternal antibodies crossing the placenta and destroying fetal red blood cells, leading to severe anemia and heart failure - Still important in under-immunized populations or cases of missed prophylaxis

Q: Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Most common is ascending infection. ***Most common is ascending infection*** - Uterine tuberculosis is overwhelmingly due to **hematogenous spread** from a primary site, often the lungs, rather than an ascending infection from the lower genital tract. - Tuberculosis typically reaches the female genital tract by the **bloodstream**, with the fallopian tubes being the most common initial site of involvement. *Mostly secondary* - Genital tuberculosis, including uterine involvement, is almost always a **secondary infection**, meaning it results from the spread of Mycobacterium tuberculosis from another primary site in the body, most commonly the lungs. - The initial infection establishes elsewhere, and then the bacteria **disseminate hematogenously** to the reproductive organs. *Increase incidence of ectopic pregnancy* - Tubal damage and scarring caused by tuberculosis, particularly in the fallopian tubes (**salpingitis**), disrupt the normal passage of the ovum. - This anatomical alteration significantly **increases the risk** of the fertilized egg implanting outside the uterus, leading to ectopic pregnancy. *Involvement of endosalpinx* - The **fallopian tubes (endosalpinx)** are the most common site of genital tuberculosis, with eventual spread to the uterus through the lymphatic system or direct extension. - Tubal involvement can lead to **salpingitis isthmica nodosa** and hydrosalpinx, contributing to infertility and ectopic pregnancy.

Q: What is the primary use of prophylactic methergin?

To stop excess bleeding from uterus. ***To stop excess bleeding from uterus*** - **Methergin (Methylergonovine)** is an **ergot alkaloid** that causes strong contractions of the **uterus**. - Its primary prophylactic use is to **prevent or treat postpartum hemorrhage** by contracting the uterus and compressing blood vessels. *Induction of labour* - **Methergin** is generally **contraindicated for labor induction** as its potent, sustained contractions can cause **hypertonic uterine dysfunction** and fetal distress. - **Oxytocin** is the preferred agent for **labor induction** due to its more physiological contraction pattern. *Induction of abortion* - While methergin can cause uterine contractions, it is **not the primary agent for abortion induction**. - **Prostaglandins (e.g., misoprostol)** and other pharmacological agents are typically used in combination for **medical abortion**. *None of the options* - This option is incorrect because **stopping excess uterine bleeding** is indeed a primary use of prophylactic methergin, particularly in the postpartum period. - The other options describe situations where methergin is either not indicated or is a secondary/contraindicated choice.

Question 1

Which of the following pelvic measurements is most commonly used in clinical practice?

Accepted Answer

Diagonal conjugate

Answer

Transverse diameter of outlet

Answer

Oblique diameter of pelvis

Answer

Anteroposterior diameter of inlet

Question 2

After delivery upto which week is known as puerperium?

Accepted Answer

6 weeks

Answer

2 weeks

Answer

4 weeks

Answer

8 weeks

Question 3

What is the most common complication that can arise from vacuum delivery during childbirth?

Accepted Answer

Cephalohematoma

Answer

Subgaleal hemorrhage

Answer

Scalp lacerations

Answer

Retinal hemorrhages

Question 4

35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?

Accepted Answer

Premature ovarian failure

Answer

Pituitary dysfunction

Answer

Hypothalamic dysfunction

Answer

Polycystic Ovary Syndrome

Question 5

What is the definitive management for adenomyosis?

Accepted Answer

Hysterectomy (surgical removal of the uterus).

Answer

Endometrial ablation.

Answer

Hormonal therapy (e.g., Danazol) for temporary symptom relief.

Answer

Hormonal therapy (e.g., GnRH analogue) for temporary symptom relief.

Question 6

Spinnbarkeit is maximum shown at which phase?

Accepted Answer

Ovulatory

Answer

Menstrual phase

Answer

Post ovulatory

Answer

Follicular phase

Question 7

In a severely anaemic pregnant patient presenting with cardiac failure, what is the most appropriate choice of transfusion?

Accepted Answer

Exchange transfusion

Answer

Platelets

Answer

Packed cells

Answer

Whole blood

Question 8

What is the most common cause of hydrops fetalis in current medical practice?

Accepted Answer

Cardiac malformations

Answer

Fetal infections (e.g., parvovirus B19)

Answer

Chromosomal abnormalities

Answer

Rh incompatibility (historically significant)

Question 9

Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Accepted Answer

Most common is ascending infection

Answer

Increase incidence of ectopic pregnancy

Answer

Involvement of endosalpinx

Answer

Mostly secondary

Question 10

What is the primary use of prophylactic methergin?

Accepted Answer

To stop excess bleeding from uterus

Answer

None of the options

Answer

Induction of labour

Answer

Induction of abortion

NEET-PG 2012 — Obstetrics and Gynecology