Obstetrics and Gynecology
8 questionsWhen the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?
Which is not a risk factor for gestational hypertension
Which of the following methods is not used for managing shoulder dystocia?
What is the primary clinical advantage of the occipitoanterior position in childbirth?
What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?
The best method for inducing mid trimester abortion is :
Which of the following conditions is ruled out in a twin pregnancy of the same age and sex?
Duration of second stage of labor (propulsive stage) in multipara
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 991: When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?
- A. Forceps may be applied if necessary. (Correct Answer)
- B. Crowning occurs at this stage.
- C. There is a risk of deep transverse arrest.
- D. Episiotomy must be performed at this station.
Explanation: ***Forceps may be applied if necessary.*** - At **station +2**, the fetal head has progressed significantly into the pelvis (2 cm below the ischial spines), indicating a **low-lying head** where instrumental delivery with **forceps** or a **vacuum extractor** can be safely performed if indicated (e.g., maternal exhaustion, fetal distress). - This station qualifies as **low forceps** or **outlet forceps** delivery, which are considered safe procedures when properly indicated. - The fetal head at this level has reached or is approaching the **pelvic floor**, meeting the prerequisites for assisted vaginal delivery. *Crowning occurs at this stage.* - **Crowning** specifically refers to the stage when the largest diameter of the fetal head is visible at the **vaginal introitus** and does not recede between contractions. - This occurs at approximately **station +4 to +5**, not at station +2. - While station +2 indicates significant descent, the fetus must descend further before crowning occurs. *There is a risk of deep transverse arrest.* - **Deep transverse arrest** occurs when the fetal head fails to internally rotate from the transverse position to an occipito-anterior or occipito-posterior position. - This complication typically occurs at **station 0 to +1** (mid-pelvis level), not at station +2. - By the time the fetal head reaches station +2 and the pelvic floor, internal rotation should have already occurred. *Episiotomy must be performed at this station.* - **Episiotomy** is **not mandatory** at any particular fetal station. - It is a selective procedure performed when indicated, typically just before crowning (around station +3 to +4), to prevent severe perineal trauma or expedite delivery. - The decision is based on clinical factors like fetal size, maternal tissue quality, and risk of severe laceration—not solely on fetal station.
Question 992: Which is not a risk factor for gestational hypertension
- A. Primigravida
- B. Factor V Leiden mutation
- C. Smoking (Correct Answer)
- D. Low maternal age
Explanation: ***Smoking*** - **Smoking** paradoxically shows a *protective effect* against gestational hypertension and preeclampsia, making it the correct answer as it is NOT a risk factor for gestational hypertension. - This well-documented phenomenon may be related to smoking's vasodilatory effects and reduced production of anti-angiogenic factors. - However, smoking carries numerous other serious risks including **intrauterine growth restriction (IUGR)**, **placental abruption**, **preterm birth**, and **perinatal mortality**. *Primigravida* - **Primigravida** (first pregnancy) is a well-established risk factor for gestational hypertension and preeclampsia. - First-time exposure to paternal antigens and incomplete immune tolerance may contribute to this increased risk. - The risk decreases in subsequent pregnancies with the same partner. *Factor V Leiden mutation* - The **Factor V Leiden mutation** is the most common inherited thrombophilia and significantly increases the risk of gestational hypertension and preeclampsia. - This mutation causes resistance to activated protein C, leading to a hypercoagulable state that can impair placental perfusion. - Associated with increased risk of venous thromboembolism during pregnancy. *Low maternal age* - **Low maternal age** (adolescent pregnancy, <20 years) is actually a recognized *risk factor* for gestational hypertension. - Young mothers may have incomplete physical and cardiovascular maturity to handle pregnancy-related physiological changes. - Adolescent pregnancies are associated with higher rates of hypertensive disorders of pregnancy.
Question 993: Which of the following methods is not used for managing shoulder dystocia?
- A. Zavanelli maneuver
- B. Wood's maneuver
- C. Hegar's maneuver (Correct Answer)
- D. McRobert's maneuver
Explanation: *McRobert's maneuver* - This maneuver is a common first-line intervention for shoulder dystocia, involving sharp **flexion of the mother's hips** back towards her abdomen to flatten the sacrum and rotate the symphysis pubis anteriorly. - It works by increasing the functional diameter of the **pelvic outlet**, potentially dislodging the anterior shoulder. ***Hegar's maneuver*** - **Hegar's sign** is a clinical finding related to early pregnancy, indicating the **softening of the lower uterine segment** (isthmus) upon bimanual examination. - It is a diagnostic sign of pregnancy and **not a method used to resolve shoulder dystocia**. *Zavanelli maneuver* - The **Zavanelli maneuver** is a last-resort intervention for shoulder dystocia, involving the **replacement of the fetal head into the uterus** followed by immediate delivery via **cesarean section**. - This is a highly invasive procedure with significant risks to both mother and fetus, used when other maneuvers have failed. *Wood's maneuver* - **Wood's maneuver** involves **rotating the fetal shoulders** by applying pressure to the posterior aspect of the anterior shoulder or the anterior aspect of the posterior shoulder to achieve a corkscrew effect. - This rotation can help dislodge an impacted shoulder or facilitate its passage under the symphysis pubis.
Question 994: What is the primary clinical advantage of the occipitoanterior position in childbirth?
- A. It is the most favorable position for vaginal delivery.
- B. It allows optimal fetal head flexion reducing the presenting diameter. (Correct Answer)
- C. Anterior fontanelle is anterior in this position.
- D. It is associated with shorter labor duration and fewer complications.
Explanation: ***It allows optimal fetal head flexion reducing the presenting diameter.*** - In the occipitoanterior (OA) position, the fetal head is **well-flexed**, allowing the **smallest diameter** of the fetal head to present to the maternal pelvis - The presenting diameter is the **suboccipitobregmatic diameter** (~9.5 cm), which is the smallest anteroposterior diameter of the fetal head - This optimal flexion is the **primary clinical advantage** as it facilitates easier passage through the birth canal and reduces maternal and fetal trauma - The **occiput (posterior fontanelle)** faces anteriorly in this position, which is a key anatomical landmark used to diagnose OA position during vaginal examination *It is the most favorable position for vaginal delivery.* - While this statement is true, it is **too general** and doesn't explain the specific anatomical or mechanical reason - It describes an outcome rather than explaining the **primary clinical advantage** in terms of fetal head mechanics *Anterior fontanelle is anterior in this position.* - This statement is **anatomically incorrect** - In occipitoanterior position, the **occiput (posterior fontanelle)** is anterior, not the anterior fontanelle - The anterior fontanelle (bregma) is actually positioned **posteriorly** in the OA position *It is associated with shorter labor duration and fewer complications.* - This is a **consequence** of the favorable OA position, not the primary clinical advantage itself - The shorter labor and fewer complications result from the optimal fetal head flexion and smaller presenting diameter - This option describes an **outcome** rather than the underlying anatomical/mechanical advantage
Question 995: What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?
- A. 96 hours
- B. 48 hours
- C. 24-48 hours (Correct Answer)
- D. 72 hours
Explanation: ***24-48 hours*** - The FDA-approved protocol for medical abortion with mifepristone and misoprostol specifies a **24- to 48-hour interval** between the administration of the two drugs. - This timing ensures optimal efficacy as it allows mifepristone to adequately sensitize the uterus to the effects of misoprostol. *48 hours* - While 48 hours falls within the recommended range, specifically stating "48 hours" as the only option is less precise than the **24-48 hour window**. - No specific clinical advantage or disadvantage is generally reported for waiting exactly 48 hours over, for instance, 24 hours. *96 hours* - A 96-hour interval is significantly longer than the **FDA-recommended window** and is not part of the standard, evidence-based protocol. - Delaying misoprostol administration beyond 48 hours may **reduce the effectiveness** of the medical abortion and increase the risk of complications. *72 hours* - A 72-hour interval exceeds the upper limit of the **FDA-recommended window** for optimal efficacy. - While some studies have explored extended intervals, the *standard clinical practice* and FDA guidelines do not endorse 72 hours as the primary recommended interval.
Question 996: The best method for inducing mid trimester abortion is :
- A. Dilation and Curettage (D&C)
- B. Injection of Hypertonic Saline
- C. Ethacrydine Lactate
- D. Prostaglandins (Correct Answer)
Explanation: ***Prostaglandins*** - **Prostaglandins** (e.g., dinoprostone, misoprostol) are highly effective in inducing uterine contractions and cervical ripening, making them the preferred method for **mid-trimester abortion**. - They can be administered through various routes (vaginal, oral, buccal) and offer a good balance of efficacy and safety for this gestational age. - Prostaglandins are considered the **current gold standard** for second-trimester medical termination of pregnancy. *Injection of Hypertonic Saline* - Historically used, but **intra-amniotic hypertonic saline** carries significant risks, including hypernatremia, disseminated intravascular coagulation (DIC), and uterine rupture. - It has largely been replaced by safer and more effective methods like prostaglandins due to its adverse event profile. - This method is now considered obsolete in most clinical settings. *Ethacrydine Lactate* - **Ethacrydine lactate** (ethacridine lactate/Rivanol) is an antiseptic agent that was historically used for mid-trimester abortion via intra-amniotic injection. - While it was effective in inducing abortion, it has been largely abandoned due to complications, prolonged induction time, and the availability of safer alternatives. - It is **not the preferred method** compared to prostaglandins, which have better safety profiles and efficacy. *Dilation and Curettage (D&C)* - **Dilation and curettage (D&C)** is primarily used for first-trimester abortions or for managing incomplete abortions and miscarriages. - In the mid-trimester, the uterus is larger and the fetal tissue is more substantial, making D&C less safe and often requiring extensive dilation or potentially leading to complications like uterine perforation or hemorrhage. - **Dilation and evacuation (D&E)** may be used in mid-trimester but requires specialized training and equipment.
Question 997: Which of the following conditions is ruled out in a twin pregnancy of the same age and sex?
- A. Monozygotic twins
- B. Superfetation (Correct Answer)
- C. Superfecundation
- D. None of the following
Explanation: ***Superfetation*** - **Superfetation** refers to the fertilization of an ovum when another pregnancy is already established in the uterus, resulting in two fetuses of **different gestational ages**. - As the question specifies a twin pregnancy of the **same age**, superfetation is ruled out. *Monozygotic twins* - **Monozygotic twins** originate from a single zygote that splits, resulting in genetically identical individuals of the **same sex** and age. - This condition is consistent with the given scenario of same-sex, same-aged twins. *Superfecundation* - **Superfecundation** is the fertilization of two or more ova from the same ovulatory cycle by sperm from **different acts of coitus** (which may involve different partners). - The twins are of the **same gestational age** (same cycle) but are **dizygotic**, and can be either the same sex or different sexes. - This condition is NOT ruled out by the criteria given in the question. *None of the following* - This option is incorrect because **superfetation** is definitively ruled out by the criteria of the question (twins of the same age).
Question 998: Duration of second stage of labor (propulsive stage) in multipara
- A. Approximately 20 minutes (Correct Answer)
- B. 40 minutes
- C. 1 hour
- D. 10 minutes
Explanation: ***Approximately 20 minutes*** - In **multiparas**, the second stage of labor, also known as the **propulsive stage**, is typically shorter due to prior experience with childbirth. - While there is variability, an average duration of **20 minutes** for this stage is commonly observed in multiparous women. *40 minutes* - A duration of 40 minutes for the propulsive stage would be considered on the longer side for a **multipara**, often approaching the upper limits of normal. - While not necessarily abnormal, it is longer than the **average expected time** for multiparous women. *1 hour* - A second stage duration of **1 hour** in a multipara would generally be considered prolonged and might warrant intervention or closer monitoring. - This duration is more consistent with the **upper limit of normal** in nulliparous women or cases of arrest of labor in multiparas. *10 minutes* - While some multiparous women may have a very rapid second stage, **10 minutes** is on the shorter end of the average. - This could indicate a **precipitous labor**, which can carry its own risks such as maternal lacerations and neonatal complications.
Pharmacology
1 questionsWhat is the primary treatment indication of folic acid?
NEET-PG 2015 - Pharmacology NEET-PG Practice Questions and MCQs
Question 991: What is the primary treatment indication of folic acid?
- A. Prevention of neural tube defects in pregnancy
- B. Treatment of megaloblastic anemia (Correct Answer)
- C. Management of hemoglobinopathies
- D. None of the above
Explanation: ***Treatment of megaloblastic anemia*** - Folic acid is essential for **DNA synthesis** and cell division, and its deficiency leads to impaired red blood cell maturation, causing **megaloblastic anemia**. - Supplementation with folic acid effectively reverses the hematological abnormalities in **folate-deficient megaloblastic anemia**. *Prevention of neural tube defects in pregnancy* - While folic acid is crucial for preventing **neural tube defects** (NTDs), this is a **prophylactic** rather than a primary therapeutic use. - The focus of this question is on the *primary therapeutic* use, implying treatment of an existing condition. *Management of hemoglobinopathies* - Hemoglobinopathies like **sickle cell anemia** or **thalassemia** are genetic disorders affecting hemoglobin structure or production, not primarily due to folic acid deficiency. - Folic acid may be given to these patients to support increased red blood cell turnover, but it does not address the underlying genetic defect. *None of the above* - This option is incorrect because folic acid has a clear primary therapeutic role in treating **megaloblastic anemia**.
Physiology
1 questionsDuring pregnancy, the increased size of the pituitary gland is primarily due to the enlargement of which hormone-secreting cells?
NEET-PG 2015 - Physiology NEET-PG Practice Questions and MCQs
Question 991: During pregnancy, the increased size of the pituitary gland is primarily due to the enlargement of which hormone-secreting cells?
- A. Growth hormone
- B. Prolactin (Correct Answer)
- C. ACTH
- D. TSH
Explanation: ***Prolactin*** - During pregnancy, the number and size of **lactotrophs**, the cells that secrete prolactin, increase significantly due to high **estrogen** levels. - This **hyperplasia** and **hypertrophy** of lactotrophs contribute to the overall enlargement of the pituitary gland, preparing it for lactation. *Growth hormone* - While growth hormone is important, there isn't a primary enlargement of **somatotrophs** (GH-secreting cells) in the pituitary during pregnancy. - Furthermore, most circulating GH during pregnancy is **placental growth hormone**, rather than pituitary-derived. *ACTH* - Adrenocorticotropic hormone (ACTH) is secreted by **corticotrophs**, and these cells do not undergo prominent hypertrophy or hyperplasia during normal pregnancy. - While cortisol levels increase, this is largely due to factors other than increased pituitary ACTH cell size. *TSH* - Thyroid-stimulating hormone (TSH) is secreted by **thyrotrophs**, which do not notably enlarge during pregnancy. - Thyroid gland activity increases during pregnancy, but this is mediated by **hCG** and other mechanisms, not pituitary thyrotroph growth.