NEET-PG 2013 Practice Questions

Q: Which type of fistula can present with both normal urinary voiding and continuous urine leakage simultaneously?

Ureterovaginal Fistula. ***Ureterovaginal Fistula*** - With a **ureterovaginal fistula**, urine can still flow from the bladder through the urethra, allowing for **normal voiding**. - Simultaneously, urine directly bypasses the bladder from the ureter into the vagina, causing **continuous leakage** independent of bladder function. *Vesicovaginal Fistula* - A **vesicovaginal fistula** typically leads to continuous urine leakage through the vagina because the bladder contents directly escape. - This often results in **no normal voiding** or significantly reduced voiding as urine does not accumulate in the bladder. *Urethrovaginal Fistula* - A **urethrovaginal fistula** connects the urethra directly to the vagina. - This usually results in **urine leakage during voiding** or when pressure is exerted, rather than continuous leakage with normal bladder emptying. *Vesicoperitoneal Fistula* - A **vesicoperitoneal fistula** involves leakage of urine from the bladder into the peritoneal cavity. - This condition presents with **ascites** and abdominal signs, not vaginal leakage or normal voiding combined with continuous leakage.

Q: Which type of suture is primarily used for the repair of a complete perineal tear?

Vicryl. ***Correct Answer: Vicryl (Polyglactin 910)*** - **Vicryl is the gold standard suture material** for repair of complete perineal tears (third and fourth-degree) - It is a **synthetic absorbable braided suture** with excellent tensile strength that maintains tissue support during critical healing phase - **Absorption profile**: Loses 50% tensile strength by 2 weeks, completely absorbed in 56-70 days, ideal for perineal tissue healing - **Minimal tissue reaction** and low infection risk compared to natural sutures - **Recommended by RCOG and ACOG guidelines** for layer-by-layer repair of perineal tears involving anal sphincter *Incorrect: Monocryl* - Monocryl (Poliglecaprone 25) is a fast-absorbing monofilament suture primarily used for **subcuticular skin closure** - Not the first choice for deep tissue repair of complete perineal tears - Has faster absorption (90-120 days) which may not provide adequate support for sphincter repair *Incorrect: Catgut* - Catgut is a natural absorbable suture that was **historically used but is now largely obsolete** - **Higher tissue reaction**, increased infection risk, and unpredictable absorption make it unsuitable - Modern synthetic sutures like Vicryl have replaced catgut in current obstetric practice *Incorrect: Silk* - Silk is a **non-absorbable suture** that is inappropriate for perineal repair - Would require removal and carries risk of chronic foreign body reaction - Never used for internal structures in perineal reconstruction

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: The mechanism by which ergometrine stops postpartum hemorrhage is that it:

Increases tone of uterine muscle. ***Increases tone of uterine muscle*** - **Ergometrine** is an **ergot alkaloid** that directly stimulates **uterine smooth muscle contractions**. - These sustained contractions lead to **compression of blood vessels within the myometrium**, thereby reducing blood flow and controlling **postpartum hemorrhage**. *Causes vasoconstriction of uterine arteries* - While ergometrine does have some generalized **vasoconstrictive effects**, its primary mechanism of action in controlling postpartum hemorrhage is not mainly through direct vasoconstriction of large uterine arteries. - The crucial effect is the **sustained uterine contraction** which mechanically occludes blood vessels, rather than chemical constriction of the vessels themselves. *Induces platelet aggregation* - Ergometrine does not primarily act by inducing **platelet aggregation**; this is a function of specific clotting factors and platelet activators. - Its therapeutic effect against hemorrhage is mediated through its action on **uterine contractility**, not on the cellular components of coagulation. *Promotes coagulation* - Ergometrine does not directly promote the **coagulation cascade** or enhance the formation of fibrin clots. - Its mechanism of action is distinct from agents that affect intrinsic or extrinsic pathways of coagulation.

Question 1

Which type of fistula can present with both normal urinary voiding and continuous urine leakage simultaneously?

Accepted Answer

Ureterovaginal Fistula

Answer

Vesicovaginal Fistula

Answer

Vesicoperitoneal Fistula

Answer

Urethrovaginal Fistula

Question 2

Which type of suture is primarily used for the repair of a complete perineal tear?

Accepted Answer

Vicryl

Answer

Monocryl

Answer

Catgut

Answer

Silk

Question 3

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 4

Hematuria in previous LSCS patient indicates -

Accepted Answer

Urinary tract infection

Answer

Placenta previa

Answer

No significant findings

Answer

Rupture uterus

Question 5

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 6

Which of the following is NOT a cause of metrorrhagia?

Accepted Answer

Intramural fibroid

Answer

Polyp

Answer

CA endometrium

Answer

IUD

Question 7

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 8

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

Accepted Answer

Mid pregnancy

Answer

Early pregnancy

Answer

Nulliparous women

Answer

Puerperium

Question 9

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 10

The mechanism by which ergometrine stops postpartum hemorrhage is that it:

Accepted Answer

Increases tone of uterine muscle

Answer

Induces platelet aggregation

Answer

Promotes coagulation

Answer

Causes vasoconstriction of uterine arteries

NEET-PG 2013

Obstetrics and Gynecology

Pharmacology