NEET-PG 2013 - Obstetrics and Gynecology Practice Questions

Q: Hematuria in previous LSCS patient indicates -

Urinary tract infection. ***Urinary tract infection*** - Hematuria in a patient with a previous **LSCS** (Lower Segment Caesarean Section) is a common symptom of a **urinary tract infection (UTI)**, as pregnancy itself, and sometimes a previous C-section, can increase UTI risk. - While a previous LSCS might alter pelvic anatomy, a UTI is a more direct and common cause of hematuria in this scenario than other obstetrical complications. *Placenta previa* - **Placenta previa** primarily causes **painless vaginal bleeding** in the second or third trimester due to the placenta covering the cervical os, not hematuria directly from the urinary tract. - While bleeding might be significant, it originates from the uterus, not the bladder, and is typically bright red vaginal bleeding. *No significant findings* - **Hematuria** is a significant finding that warrants investigation, as it indicates blood in the urine and is never considered "no significant finding." - It could be a sign of various underlying conditions, ranging from benign to serious, necessitating evaluation. *Rupture uterus* - **Uterine rupture** is a catastrophic event in pregnancy, often presenting with **severe abdominal pain**, fetal distress, and significant **vaginal bleeding**, not isolated hematuria. - While it's a serious complication, the blood would primarily be from the uterus or internal hemorrhage, not directly in the urine.

Q: What is meant by 'Battledore insertion of placenta'?

Umbilical cord attached to the margin of the placenta. ***Umbilical cord attached to the margin of the placenta*** - In a **Battledore insertion**, the **umbilical cord** inserts into the **edge** or **margin** of the placenta, rather than its center. - This unusual insertion resembles a **battledore**, a type of ancient racket or paddle with a handle at its edge (similar to those used in shuttlecock games). *Placenta attached to the margin of the membranes* - This description is more consistent with a **circumvallate placenta**, where the chorionic plate is smaller than the basal plate, leading to a rolled or folded margin of placental tissue covered by membranes, but it does not describe Battledore insertion. - In circumvallate placenta, the chorionic plate's edge rolls back and is surrounded by a ring of membranes, while Battledore refers specifically to the cord's insertion. *Placenta attached to the center of the uterus* - This simply indicates a **normal location** for the placenta within the uterine cavity and does not describe any abnormal insertion of the umbilical cord or specific characteristics of the placenta itself. - The placenta typically attaches to the uterine wall and can be central, fundal, or anterior/posterior, but this statement doesn't relate to the cord's insertion point. *Umbilical cord attached to the membranes* - This condition is known as **velamentous insertion of the umbilical cord**, where the cord blood vessels fan out within the amniotic membrane before reaching the placental tissue. - Velamentous insertion is a distinct anomaly from Battledore insertion and carries different risks, such as vasa previa and a higher risk of vessel compression or rupture.

Q: Which of the following is NOT a cause of metrorrhagia?

Intramural fibroid. ***Intramural fibroid*** - **Intramural fibroids** are located within the uterine wall and are **primarily associated with menorrhagia** (heavy or prolonged menstrual bleeding during regular periods) rather than metrorrhagia. - Their main effect is to increase the endometrial surface area and impair uterine contractility, leading to **heavy regular menstrual flow**. - While they can occasionally cause irregular bleeding if complicated by degeneration or severe distortion, this is **not their typical presentation**, making them the **least characteristic cause** of metrorrhagia among the given options. *Polyp* - **Endometrial polyps** are **classic causes of metrorrhagia** because their friable surface bleeds irregularly, especially with hormonal fluctuations or minor trauma. - They commonly present with **intermenstrual spotting** and post-coital bleeding, making them a typical cause of irregular bleeding. *CA endometrium* - **Endometrial carcinoma** is a **frequent cause of metrorrhagia**, particularly in postmenopausal women, due to irregular shedding of friable malignant tissue. - The abnormal vascular supply and tissue breakdown in cancer results in **unpredictable, irregular bleeding episodes** characteristic of metrorrhagia. *IUD* - **Intrauterine devices** are **well-known causes of metrorrhagia**, particularly copper IUDs, which cause endometrial irritation and increased prostaglandin release. - Both copper and hormonal IUDs frequently cause **spotting and irregular intermenstrual bleeding**, especially in the first 3-6 months after insertion.

Q: Bonney's test is used to determine which of the following?

Urinary incontinence due to stress. ***Urinary incontinence due to stress*** - **Bonney's test** is specifically designed to assess whether a patient's **stress urinary incontinence** is correctable by elevating the urethrovesical junction. - A positive result, where urine leakage stops with elevation, suggests that surgical correction to support the urethra may be beneficial. *Uterine prolapse* - While related to pelvic floor dysfunction, **uterine prolapse** is assessed by clinical examination for descent of the uterus, not specifically with Bonney's test. - Its presence is determined by visible or palpable protrusion of the cervix or uterus through the vaginal opening. *Vesicovaginal fistula* - A **vesicovaginal fistula** involves an abnormal connection between the bladder and vagina, leading to continuous urine leakage. - This condition is typically diagnosed using dye tests (e.g., tampon test) or cystoscopy, not Bonney's test. *Ureteric fistula* - A **ureteric fistula** is an abnormal connection involving the ureter, often resulting in continuous urine leakage outside the normal urinary tract. - Diagnosis usually involves imaging studies like IV urography or CT urogram, as Bonney's test is not relevant for this condition.

Q: Red degeneration of fibroid is seen in which of the following?

Mid pregnancy. ***Mid pregnancy*** - **Red degeneration**, or **carneous degeneration**, is most common during the **second and third trimesters of pregnancy** due to increased metabolic demands of the growing fibroid outstripping its blood supply. - The rapid growth leads to **ischemia**, hemorrhage, and necrosis within the fibroid, causing acute abdominal pain. *Early pregnancy* - While fibroids can grow in early pregnancy, **red degeneration** is less common as the uterine blood supply is generally still adequate to meet the fibroid's metabolic needs. - Other forms of degeneration, like **hyaline degeneration**, are more frequently observed in non-pregnant or early pregnant states. *Puerperium* - In the puerperium, fibroids typically undergo **regression** rather than degeneration, as the hormonal stimulation (estrogen and progesterone) that promoted their growth significantly decreases. - The uterus involutes rapidly, and fibroids often shrink. *Nulliparous women* - Nulliparous women can have fibroids and experience various forms of degeneration, but **red degeneration** specifically is rare outside of pregnancy. - Degeneration in nulliparous women is more commonly **hyaline** or **cystic** degeneration.

Q: Which of the following statements about radical hysterectomy in stage Ib cervical cancer compared to radiotherapy is false?

It is less complicated than radiotherapy.. ***It is less complicated than radiotherapy.*** - Radical hysterectomy is a **major surgical procedure** with potential complications like **hemorrhage**, infection, **ureteral injury**, and **lymphedema**, which can be significant and life-altering. - Radiotherapy, while having its own set of side effects (e.g., **vaginal stenosis**, bladder/rectal irritation), typically avoids the acute surgical risks and recovery period associated with extensive surgery. *Chance of recurrence is lower with radical hysterectomy.* - For early-stage cervical cancer (Ib1/Ib2), both **radical hysterectomy** and **radiotherapy** provide **comparable outcomes** in terms of recurrence rates. - The choice between therapies often depends on patient factors, surgeon expertise, and pathological findings, but neither consistently demonstrates a significantly lower recurrence rate over the other in large cohorts. *Ovarian function can be preserved.* - In younger patients undergoing **radical hysterectomy**, it is often possible to **preserve the ovaries** by transplanting them or avoiding their removal if not directly involved, thus maintaining **endocrine function**. - **Pelvic radiotherapy**, in contrast, invariably leads to **ovarian radiation** and subsequent **ovarian failure** and menopause. *Chance of survival is higher with radical hysterectomy.* - For early-stage cervical cancer (Ib), **overall survival rates** are generally **equivalent** between radical hysterectomy and primary radiotherapy. - Meta-analyses and large retrospective studies have shown **similar 5-year survival rates** for both treatment modalities when applied appropriately to well-selected patients.

Q: A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?

Stage 3C. ***Stage 3C*** - **Bilateral ovarian carcinoma** with **capsule involvement**, **ascites**, and especially **paraaortic lymph node metastases** are defining features of Stage IIIC ovarian cancer. - Involvement of **retroperitoneal lymph nodes**, including paraaortic nodes, automatically upstages the disease to Stage III, irrespective of other abdominal spread. *Stage 1C* - This stage refers to ovarian cancer confined to **one or both ovaries**, with evidence of rupture, capsule involvement, or malignant cells in ascites/peritoneal washings, but **without lymph node involvement**. - The presence of **paraaortic lymphadenopathy** in this patient immediately excludes Stage 1C. *Stage 2C* - Stage 2 ovarian cancer involves one or both ovaries with **pelvic extension** beyond the ovaries, but still **without lymph node involvement**. - The patient's involvement of **paraaortic lymph nodes** goes beyond pelvic extension and therefore excludes Stage 2C. *Stage 4C* - Stage 4 ovarian carcinoma involves **distant metastasis** beyond the peritoneal cavity or distant lymph nodes (e.g., pleural effusion with positive cytology, parenchymal liver/spleen metastasis). - While paraaortic lymphadenopathy indicates advanced disease, it falls within the criteria for Stage 3 due to its location, not Stage 4.

Q: Most common presentation of cervical cancer is -

Abnormal vaginal bleeding. ***Abnormal vaginal bleeding*** - **Abnormal vaginal bleeding** is the most frequent presenting symptom of cervical cancer, often manifesting as **postcoital bleeding**, intermenstrual bleeding, or heavier, longer menstrual periods. - This symptom arises as the tumor on the cervix ulcerates and bleeds due to its friable nature and rich vascularization. *Pelvic pain* - **Pelvic pain** is typically a symptom of more **advanced cervical cancer**, indicating tumor invasion into surrounding tissues or nerves. - It is not usually an early or the most common presenting symptom, unlike abnormal bleeding. *Pain during intercourse* - **Pain during intercourse (dyspareunia)** can be a symptom of cervical cancer, particularly with larger lesions or those causing inflammation. - However, it is less common than abnormal bleeding and often occurs concurrently with or after the onset of bleeding symptoms. *Unusual vaginal discharge* - An **unusual vaginal discharge**, which may be watery, foul-smelling, or blood-tinged, can occur with cervical cancer. - While a common symptom, it is generally considered less frequent than abnormal vaginal bleeding as the primary presenting complaint.

Q: What is the first-line treatment for simple hyperplasia of the endometrium?

Progestin therapy (e.g., Medroxyprogesterone acetate). ***Progestin therapy (e.g., Medroxyprogesterone acetate)*** - **Progestin therapy** is the first-line treatment for simple endometrial hyperplasia because it counteracts the unopposed estrogen effect causing the hyperplasia. - **Progestins** lead to endometrial atrophy and shedding, helping to reverse the hyperplastic changes and prevent progression to cancer. *Estrogen therapy (e.g., Estradiol)* - **Estrogen therapy** without concomitant progestins would exacerbate endometrial hyperplasia by further stimulating endometrial growth. - This treatment is contraindicated in cases of endometrial hyperplasia unless carefully balanced with progestins. *Endometrial ablation (surgical procedure)* - **Endometrial ablation** is a destructive procedure to remove the endometrial lining and is typically considered for persistent abnormal uterine bleeding, not as a primary treatment for simple hyperplasia. - It is often reserved for patients who have completed childbearing and fail medical management. *Total abdominal hysterectomy (surgical removal of the uterus)* - A **total abdominal hysterectomy** is an invasive surgical procedure that is generally reserved for complex or atypical endometrial hyperplasia, or hyperplasia that is recurrent and unresponsive to medical management. - It is not the first-line treatment for simple hyperplasia, especially in patients who may desire future fertility or wish to avoid major surgery.

Question 1

What is the management of eclampsia at 34 weeks of pregnancy?

Accepted Answer

Administer antihypertensives, anticonvulsants, and consider termination of pregnancy.

Answer

Continue convulsions and wait for 37 weeks to complete.

Answer

Wait for spontaneous labor.

Answer

Continue blood pressure management.

Question 2

Hematuria in previous LSCS patient indicates -

Accepted Answer

Urinary tract infection

Answer

Placenta previa

Answer

No significant findings

Answer

Rupture uterus

Question 3

What is meant by 'Battledore insertion of placenta'?

Accepted Answer

Umbilical cord attached to the margin of the placenta

Answer

Placenta attached to the margin of the membranes

Answer

Placenta attached to the center of the uterus

Answer

Umbilical cord attached to the membranes

Question 4

Which of the following is NOT a cause of metrorrhagia?

Accepted Answer

Intramural fibroid

Answer

Polyp

Answer

CA endometrium

Answer

IUD

Question 5

Bonney's test is used to determine which of the following?

Accepted Answer

Urinary incontinence due to stress

Answer

Uterine prolapse

Answer

Vesicovaginal fistula

Answer

Ureteric fistula

Question 6

Red degeneration of fibroid is seen in which of the following?

Accepted Answer

Mid pregnancy

Answer

Early pregnancy

Answer

Nulliparous women

Answer

Puerperium

Question 7

Which of the following statements about radical hysterectomy in stage Ib cervical cancer compared to radiotherapy is false?

Accepted Answer

It is less complicated than radiotherapy.

Answer

Chance of recurrence is lower with radical hysterectomy.

Answer

Ovarian function can be preserved.

Answer

Chance of survival is higher with radical hysterectomy.

Question 8

A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?

Accepted Answer

Stage 3C

Answer

Stage 1C

Answer

Stage 2C

Answer

Stage 4C

Question 9

Most common presentation of cervical cancer is -

Accepted Answer

Abnormal vaginal bleeding

Answer

Pelvic pain

Answer

Pain during intercourse

Answer

Unusual vaginal discharge

Question 10

What is the first-line treatment for simple hyperplasia of the endometrium?

Accepted Answer

Progestin therapy (e.g., Medroxyprogesterone acetate)

Answer

Endometrial ablation (surgical procedure)

Answer

Estrogen therapy (e.g., Estradiol)

Answer

Total abdominal hysterectomy (surgical removal of the uterus)

NEET-PG 2013 — Obstetrics and Gynecology