NEET-PG 2013 — Obstetrics and Gynecology
89 Previous Year Questions with Answers & Explanations
Uterine rupture is least common with which of the following surgical techniques?
All of the following are postcoital contraception methods except?
Which type of pelvis is most suitable for childbirth in females?
Dysfunctional uterine bleeding (DUB) is best treated by:
What is the best method to assess endometrial activity?
What is a cochleate uterus?
Ovulation occurs how long after the LH surge peak?
Human sperm remains fertile for how many hours in a female genital tract ?
Which of the following is classified as a third generation Intrauterine Contraceptive Device (IUCD)?
Which among the following is an absolute contraindication of Hormone replacement therapy?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1: Uterine rupture is least common with which of the following surgical techniques?
- A. LSCS (Correct Answer)
- B. Classical section
- C. T Shaped incision
- D. Inverted T shaped incision
Explanation: ***LSCS*** - A **low transverse uterine incision** (LSCS) is associated with the **lowest risk of uterine rupture** in subsequent pregnancies due to the lower uterine segment's thinner muscle and better healing properties. - The scar from an LSCS is less likely to undergo dehiscence during labor compared to incisions in the thicker, more contractile upper uterine segment. *Classical section* - A **classical uterine incision** (vertical incision in the upper uterine segment) carries the **highest risk of uterine rupture** in subsequent pregnancies. - This is because the upper uterine segment is thicker and more contractile, leading to a weaker scar that is more prone to tearing during labor. *T Shaped incision* - A **T-shaped incision** involves a transverse cut with a vertical extension, carrying a **high risk of uterine rupture**. - The combination of perpendicular incisions compromises the uterine wall's integrity more severely than a simple transverse cut. *Inverted T shaped incision* - An **inverted T-shaped incision** is a complex uterine incision that extends vertically into the fundus from a transverse cut, making it structurally weaker. - This type of incision significantly **increases the risk of uterine rupture** in future pregnancies due to the extensive scarring across multiple planes of muscle fibers.
Question 2: All of the following are postcoital contraception methods except?
- A. IUD
- B. Levonorgestrel
- C. Mifepristone
- D. Barrier methods (Correct Answer)
Explanation: ***Barrier methods*** - **Barrier methods** like condoms or diaphragms are used *during* intercourse to prevent pregnancy and STIs. - They are not a form of **postcoital contraception** as they do not act *after* unprotected sex has occurred. *Mifepristone* - **Mifepristone** can be used as an **emergency contraceptive** by delaying or inhibiting ovulation, or by altering the endometrium to prevent implantation. - It works *after* unprotected intercourse and is an effective form of **postcoital contraception**. *IUD* - The **copper intrauterine device (IUD)** can be inserted as an **emergency contraceptive** up to 5 days after unprotected intercourse. - It prevents pregnancy primarily by creating a **spermicidal inflammatory reaction** in the uterus, making it unsuitable for implantation. *Levonorgestrel* - **Levonorgestrel-only pills** are a common form of **emergency contraception**, sometimes known as the "morning-after" pill. - They work by **delaying or inhibiting ovulation** and are effective when taken *within 72 hours* of unprotected sex.
Question 3: Which type of pelvis is most suitable for childbirth in females?
- A. Gynaecoid (Correct Answer)
- B. Android
- C. Anthropoid
- D. Platypelloid
Explanation: ***Gynaecoid*** - The **gynaecoid pelvis** is considered the classic female pelvis, with an **adequate, rounded inlet** and spacious dimensions that are optimal for vaginal delivery. - It has a wide and deep sacral curve, a wide subpubic angle, and parallel side walls, all facilitating the passage of the fetal head. *Android* - The **android pelvis** is typically male-like, characterized by a **heart-shaped or wedge-shaped inlet** and a narrow subpubic angle. - This shape makes it more difficult for the fetal head to engage and descend, often leading to prolonged labor or necessitating a cesarean section. *Anthropoid* - The **anthropoid pelvis** has an **oval-shaped inlet** that is wider in the anterior-posterior diameter and narrower in the transverse diameter. - While possible for delivery, the narrow transverse diameter can sometimes lead to difficulty with engagement or require a persistent occiput posterior presentation. *Platypelloid* - The **platypelloid pelvis** is characterized by a **flat, transverse oval inlet** and a short anterior-posterior diameter. - This shape is the least common and presents significant challenges for vaginal delivery, as the fetal head may not be able to engage due to the narrow anterior-posterior diameter.
Question 4: Dysfunctional uterine bleeding (DUB) is best treated by:
- A. Curettage of uterus
- B. Progestogen (Correct Answer)
- C. Estrogen
- D. Clomiphene
Explanation: ***Progestogen*** - **Progestogen** therapy helps stabilize the **endometrium**, reducing excessive or irregular bleeding in DUB by counteracting unopposed estrogen. - It induces a more organized shedding of the uterine lining, which can regularize the menstrual cycle. *Curettage of uterus* - While **curettage** can provide temporary relief by removing the endometrial lining, it is primarily a diagnostic procedure to rule out pathology rather than a primary long-term treatment for DUB. - It does not address the underlying hormonal imbalance that causes DUB, leading to a high recurrence rate of symptoms. *Estrogen* - **Estrogen** therapy alone is generally not used to treat DUB because unopposed estrogen is often the cause of DUB, leading to **endometrial overgrowth** and irregular shedding. - Administering estrogen without a progestin could exacerbate the condition and increase endometrial proliferation. *Clomiphene* - **Clomiphene** is an anti-estrogen medication primarily used to induce **ovulation** in women with infertility. - It is not indicated for the management of dysfunctional uterine bleeding or for regulating menstrual cycles directly.
Question 5: What is the best method to assess endometrial activity?
- A. Endometrial biopsy (Correct Answer)
- B. HSG
- C. USG
- D. Colposcopy
Explanation: ***Biopsy*** - **Endometrial biopsy** provides direct tissue samples, allowing for histological examination of the endometrial glands and stroma to assess their phase (proliferative, secretory) and underlying pathology. - This method is considered the **gold standard** for accurately determining endometrial activity and diagnosing conditions like hyperplasia or carcinoma. *HSG* - **Hysterosalpingography (HSG)** is primarily used to evaluate the patency of the fallopian tubes and the shape of the uterine cavity, not the functional activity of the endometrium itself. - It involves injecting contrast dye and taking X-rays, which helps identify structural abnormalities but does not provide microscopic details of endometrial tissue. *USG* - **Transvaginal ultrasonography (USG)** measures endometrial thickness and identifies gross structural abnormalities like polyps or fibroids. - While it can suggest the endometrial phase based on thickness, it does not offer the definitive cellular-level detail of endometrial activity that a biopsy provides. *Colposcopy* - **Colposcopy** is a procedure used to visualize the cervix and vagina with a magnified view, primarily for detecting and evaluating abnormal cells that may lead to cervical cancer. - It is **not used** for assessing the endometrial lining or its physiological activity.
Question 6: What is a cochleate uterus?
- A. Large uterus
- B. Acute anteflexion (Correct Answer)
- C. Acute retroflexion
- D. Large cervix
Explanation: ***Acute anteflexion*** - A **cochleate uterus** describes a uterus with an **acute anteflexion**, meaning it is sharply bent forward at the junction of the cervix and the body of the uterus. - This anatomical variation can sometimes be associated with **dysmenorrhea** or difficulty with **intrauterine device (IUD) insertion**. *Large uterus* - A large uterus, also known as **uteromegaly**, is a general descriptive term for an enlarged uterus, which can be due to various causes such as **fibroids** or **adenomyosis**, and is not specific to an acute anteflexion. - It does not directly describe the acute angulation that defines a cochleate uterus. *Acute retroflexion* - **Acute retroflexion** refers to a uterus that is sharply bent backward at the level of the cervix. - This is the opposite of **anteflexion**, which describes a forward bend, and therefore is not a cochleate uterus. *Large cervix* - A **large cervix** describes an enlarged uterine cervix, which is the lower, narrow part of the uterus. - This typically relates to conditions like **cervical hypertrophy** or **nabothian cysts** and is distinct from the overall angulation of the uterine body in relation to the cervix.
Question 7: Ovulation occurs how long after the LH surge peak?
- A. 48-72 hours
- B. 72-96 hours
- C. 24-48 hours
- D. 12-24 hours (Correct Answer)
Explanation: ***12-24 hours*** - Ovulation, the release of a mature egg from the **ovary**, typically occurs within **12 to 24 hours after the peak of the luteinizing hormone (LH) surge**. - The LH surge itself usually lasts 24 to 48 hours and is a critical signal for the final maturation and release of the oocyte. *24-48 hours* - While the **LH surge** can last up to 48 hours, **ovulation** (the actual release of the egg) generally happens more rapidly, usually within 12-24 hours of the *peak* of this surge. - This timeframe is a common misconception, as it refers more to the duration of the surge rather than the precise timing of ovulation post-peak. *48-72 hours* - Ovulation rarely occurs this late after the peak of the **LH surge**; if it does, it suggests a potential delay or irregularity in the **ovulatory process**. - The window for successful fertilization is relatively narrow and aligns with the more immediate post-surge timing. *72-96 hours* - This time frame is significantly beyond the typical window for **ovulation** following the **LH surge**. - By this point, the egg would have either been released or the ovulatory event would have passed without the egg releasing.
Question 8: Human sperm remains fertile for how many hours in a female genital tract ?
- A. 6-8 hrs
- B. 12-24 hrs
- C. 24-48 hrs
- D. Up to 5 days (120 hrs) (Correct Answer)
Explanation: ***Up to 5 days (120 hrs)*** - **Sperm viability** within the female reproductive tract can extend up to **5 days (120 hours)** under optimal conditions. - This extended viability is crucial for fertility, as it allows for fertilization even if ovulation occurs several days after intercourse. *6-8 hrs* - This timeframe is significantly **too short** for typical human sperm viability in the female genital tract. - While some sperm may lose motility or viability relatively quickly, a substantial portion remains viable for much longer. *12-24 hrs* - This represents the average **lifespan of an ovum** (egg) after ovulation, not the typical viability of sperm. - Sperm generally survive longer than an unfertilized egg. *24-48 hrs* - This duration underestimates the maximum potential survival time of human sperm in the female reproductive tract. - While many sperm may be viable within this period, it does not represent the full potential for fertilization.
Question 9: Which of the following is classified as a third generation Intrauterine Contraceptive Device (IUCD)?
- A. Mirena (Correct Answer)
- B. Nova-T
- C. Lippe's loop
- D. CuT-200
Explanation: ***Mirena*** - Mirena (levonorgestrel-releasing intrauterine system) is a **third-generation IUCD** that releases **progestin**, offering both contraceptive and therapeutic benefits. - Its mechanism of action involves **thickening cervical mucus**, thinning the uterine lining, and inhibiting sperm motility/viability. *Nova-T* - Nova-T is a **second-generation IUCD** that uses **copper** as its active contraceptive agent. - Copper IUCDs like Nova-T primarily work by causing a **sterile inflammatory reaction** in the uterus, making it spermicidal. *Lippe's loop* - Lippe's loop is a **first-generation IUCD** made of inert plastic, designed to **physically block** fertilization. - It is no longer widely used due to higher rates of expulsion and complications compared to newer generations. *CuT-200* - CuT-200 is a **second-generation IUCD** that releases **copper** to prevent pregnancy. - It works by producing a **local inflammatory response** in the uterus that is toxic to sperm and eggs.
Question 10: Which among the following is an absolute contraindication of Hormone replacement therapy?
- A. Endometriosis
- B. Heart disease
- C. Breast carcinoma (Correct Answer)
- D. Osteoarthritis
Explanation: ### Breast carcinoma - Hormone replacement therapy (HRT) is **contraindicated** in breast carcinoma because many breast cancers are **estrogen-receptor positive**, meaning estrogen can stimulate their growth [1]. - Using HRT in patients with a history of breast cancer significantly increases the risk of **recurrence** or **progression** of the disease [1]. *Endometriosis* - Endometriosis is not an **absolute contraindication**; HRT can sometimes be used in women with a history of endometriosis, especially if a hysterectomy and bilateral oophorectomy have been performed. - However, unopposed estrogen therapy might **exacerbate** remaining endometrial implants, so a combined estrogen-progestin regimen is typically preferred [1]. *Heart disease* - While HRT has been shown to have **risks** in women with established coronary heart disease, it is not an absolute contraindication for all forms of heart disease. - The **Women's Health Initiative study** demonstrated increased cardiovascular events in older women initiating HRT, but current guidelines suggest that timing of initiation is crucial and benefits may outweigh risks for younger postmenopausal women. *Osteoarthritis* - Osteoarthritis is **not a contraindication** to HRT; in fact, some studies suggest that estrogen may have protective effects on cartilage [2]. - HRT is neither a treatment nor a contraindication for osteoarthritis and does not significantly impact its progression or severity [2].