NEET-PG 2012 - Obstetrics and Gynecology Practice Questions

Q: Palmer sign is related to ?

Uterine contractions palpable through rectum during labor. ***Uterine contractions palpable through rectum during labor*** - **Palmer sign** refers to the palpation of **uterine contractions** through the rectum, particularly during the early stages of labor or even in simulated labor pains. - This sign is an indicator used to assess uterine activity, especially when vaginal examination might be less informative or desired. *Softening of the cervix during pregnancy* - This describes **Goodell's sign**, which is caused by increased vascularity and edema of the cervix during early pregnancy. - While an important sign of pregnancy, it is not referred to as Palmer sign. *Bluish discoloration of cervix and vagina* - This phenomenon is known as **Chadwick's sign**, resulting from increased blood flow to the reproductive organs during pregnancy. - It is an early indication of pregnancy but distinct from the uterine contraction palpation. *Increased pulsations in uterine arteries* - This is known as **Osiander’s sign** or **uterine souffle**, characterized by a soft blowing sound over the uterus due to increased blood flow through the uterine arteries. - It is a vascular sign of pregnancy and not related to uterine contractions felt rectally.

Q: Gold standard technique for diagnosis of endometriosis?

Laparoscopy. ***Laparoscopy*** - **Laparoscopy** allows for direct visualization of endometrial implants and enables **biopsy confirmation**, making it the gold standard. - This minimally invasive surgical procedure is crucial for diagnosing, staging, and often treating endometriosis simultaneously. *Ca 125 level* - **CA-125** is a serum marker that can be elevated in endometriosis, but it is **not specific** and can be raised in other conditions like ovarian cancer or physiologic states. - It is primarily used for monitoring treatment response or recurrence, rather than as a primary diagnostic tool. *Ultrasound* - **Transvaginal ultrasound (TVS)** can identify endometriomas (chocolate cysts) and deep infiltrating endometriosis, but it cannot reliably visualize small peritoneal implants. - While it's a good initial imaging modality, its sensitivity for diagnosing all forms of endometriosis is **limited**. *MRI* - **MRI** offers better soft tissue contrast than ultrasound and can identify deep infiltrating endometriosis and some peritoneal implants, especially those involving the bowel or bladder. - However, MRI is **more expensive** and less accessible, and it still cannot definitively rule out all small, superficial endometrial lesions without direct visualization.

Q: Which of the following statements about Asherman's syndrome is true?

Characterized by intrauterine adhesions. ***Characterized by intrauterine adhesions*** - **Asherman's syndrome** is fundamentally defined by the presence of **intrauterine adhesions** or scarring of the uterine cavity. - These adhesions develop following trauma to the basal layer of the endometrium, often from gynecological procedures like **dilation and curettage (D&C)**. - This is the **pathognomonic feature** that defines the syndrome. *Progesterone challenge test is positive* - The **progesterone challenge test** assesses the presence of an intact endometrium and adequate estrogen priming. - In Asherman's syndrome, due to the scarred endometrium, the response to progesterone is typically **absent or minimal**, leading to a **negative** result. - A negative progesterone challenge test indicates outflow obstruction or endometrial non-responsiveness. *May be secondary to TB* - While **genital tuberculosis** can cause intrauterine adhesions and is a recognized etiology, it represents a **small minority** of cases. - The primary etiology of Asherman's syndrome is usually **iatrogenic**, following uterine instrumentation such as D&C, particularly post-partum or post-abortion. - TB-related adhesions may have additional features like caseating granulomas. *Not associated with menstrual irregularities* - This is **false** - Asherman's syndrome is classically associated with **menstrual irregularities**. - Common presentations include **hypomenorrhea** (scanty periods), **amenorrhea** (absent periods), or oligomenorrhea. - These menstrual changes result from the reduced functional endometrium available for cyclical shedding due to intrauterine adhesions.

Q: What is the investigation of choice in postmenopausal bleeding?

Ultrasound. ***Ultrasound*** - An initial **transvaginal ultrasound** is the investigation of choice to assess the endometrial thickness in postmenopausal bleeding. An endometrial thickness of >4-5mm often warrants further investigation. - It helps in **ruling out endometrial pathologies** like hyperplasia, polyps, or carcinoma. *PAP smear* - A **PAP smear** is a screening test for cervical cancer, not typically used to investigate postmenopausal bleeding originating from the uterus. - While it can detect some endometrial cells, it is **not sensitive** or specific enough to diagnose the cause of postmenopausal bleeding. *Laparoscopy* - **Laparoscopy** is a surgical procedure used to visualize pelvic organs and is generally employed for diagnosing and treating conditions like endometriosis, ovarian cysts, or ectopic pregnancies. - It is **not the initial investigation** for postmenopausal bleeding and is too invasive for primary diagnosis unless other methods have failed or a specific pathology is suspected. *Fractional curettage* - **Fractional curettage** involves scraping the lining of the cervix and uterus to obtain tissue samples for histological examination. - While it can be diagnostic for endometrial pathology, it is typically performed **after an initial ultrasound** has identified increased endometrial thickness or other suspicious findings, and less commonly as a standalone initial investigation.

Q: Which structure is least likely to be injured during common gynecological procedures?

Renal pelvis. ***Renal pelvis*** - The **renal pelvis** is anatomically distant from the surgical fields of most common gynecological procedures, making injury unlikely. - Its protected position deep within the abdominal cavity, surrounded by fat and muscle, generally shields it from inadvertent trauma during pelvic surgery. *Ureter at pelvic brim* - The **ureter** crosses the **pelvic brim**, an area often involved in gynecological dissections, especially during procedures like **pelvic lymphadenectomy** or management of large masses. - It is susceptible to injury during instrumentation or clamping in this region due to its close proximity to pelvic vessels. *Urinary bladder* - The **urinary bladder** is frequently in the surgical field during gynecological procedures, particularly those involving the anterior vaginal wall, cervix, or uterus (e.g., **hysterectomy**, **cystocele repair**). - Its thin wall and close proximity make it vulnerable to perforation, laceration, or thermal injury. *Ureter at infundibulopelvic ligament* - The **ureter** passes perilously close to the **infundibulopelvic ligament** (suspensory ligament of the ovary) as it enters the pelvis. - This area is frequently ligated or clamped during **oophorectomy** or adnexal mass removal, placing the ureter at high risk of kinking, ligation, or transection.

Q: Which fetal presentation is the rarest?

Shoulder. ***Shoulder*** - **Shoulder presentation** (also known as a **transverse lie**) occurs in approximately **0.3% of pregnancies** at term, making it the rarest presentation among the major fetal lie categories. - In this presentation, the fetal long axis is perpendicular to the maternal long axis, and the **shoulder** is typically the presenting part. - Vaginal delivery is not possible, and **cesarean section is mandatory**. *Cephalic* - **Cephalic presentation** is the most common presentation, occurring in about **95% of pregnancies**. - In this presentation, the fetal head is directed downwards towards the maternal pelvis. - This includes vertex, face, brow, and other head-first presentations. *Breech* - **Breech presentation** occurs when the fetal buttocks or feet are the presenting part, seen in about **3-4% of term pregnancies**. - While less common than cephalic, it is significantly more frequent than shoulder presentation. - Includes frank, complete, and footling breech variants. *Face* - **Face presentation** is a rare variant of cephalic presentation where the **fetal face** (chin/mentum) is the presenting part, occurring in about **0.2-0.3% of deliveries**. - The fetal head is hyperextended, with the occiput against the fetal back. - While rare, it is still slightly more common than shoulder presentation in some studies.

Q: Vaginal pH before puberty is?

Neutral (around 7). ***Neutral (around 7)*** - Before puberty, the vagina lacks the influence of **estrogen**, which is essential for the colonization of **Lactobacillus** bacteria. - Without Lactobacillus, there is no significant production of lactic acid, resulting in a **neutral pH** environment. *Approximately 6* - A pH of approximately 6 is still slightly acidic but less so than a mature vagina. - This value is not typical for the prepubertal stage, which generally represents an environment without significant acidic production. *Approximately 4.5* - A pH of approximately 4.5 is characteristic of a **healthy, estrogenized adult vagina** where **Lactobacillus** bacteria produce lactic acid. - This acidic environment is crucial for protecting against pathogenic infections and is not found in prepubertal individuals. *Approximately 5* - A pH of approximately 5 is acidic, though less so than the optimal adult vaginal pH. - This value indicates some lactic acid production, which is minimal or absent before the onset of puberty.

Q: What is the treatment for uterine prolapse in nulliparous women?

Manchester operation. ***Manchester operation*** - This procedure is sometimes considered for **nulliparous women** with uterine prolapse, particularly if combined with cervical elongation. - It involves **amputation of the cervix** and support of the cardinal ligaments, which can address the prolapse while preserving uterine function. *Sling used involving rectus sheath* - A sling using the rectus sheath is typically employed for **stress urinary incontinence**, not primarily for uterine prolapse. - While it supports the urethra and bladder neck, it does not directly address the descent of the uterus. *Anterior colporrhaphy* - This procedure repairs a **cystocele** (prolapse of the bladder into the vagina) by tightening the anterior vaginal wall. - It does not directly manage **uterine prolapse** itself, though a cystocele can coexist with uterine descent. *Posterior colporrhaphy* - This surgical repair targets a **rectocele** (prolapse of the rectum into the vagina) by tightening the posterior vaginal wall. - Similar to anterior colporrhaphy, it addresses a specific vaginal wall defect rather than the **uterine position**.

Q: Nuchal translucency is used in

ANC USG. ***ANC USG*** - **Nuchal translucency** measurement is a key component of the **first-trimester antenatal ultrasound** (ANC USG). - It helps in screening for chromosomal abnormalities like **Down syndrome (Trisomy 21)** and certain cardiac defects. *Head scan* - A head scan (e.g., CT or MRI of the head) is used to evaluate the **brain** and **skull** for conditions like tumors, strokes, or trauma. - It is not routinely used for fetal screening or nuchal translucency assessment. *MRI neck* - **MRI of the neck** is employed to visualize soft tissues, blood vessels, and bones in the neck region. - Its primary use is in diagnosing conditions like cervical disc herniations, spinal cord compression, or neck masses, not for fetal screening. *Anthropometry* - **Anthropometry** involves the measurement of the human body, such as height, weight, and limb circumference. - While general measurements are taken during pregnancy, anthropometry specifically does not refer to the assessment of nuchal translucency.

Q: What is the typical pH of the vagina in a pregnant woman?

4.0. ***4.0*** - The typical vaginal pH in a pregnant woman is **acidic**, generally ranging from 3.5 to 4.5, with **4.0 being the most commonly cited average value** during pregnancy. - This **acidic environment** is crucial for maintaining a healthy vaginal flora, primarily dominated by **Lactobacillus species**, which produce lactic acid from glycogen deposits in vaginal epithelium. - The increased estrogen levels during pregnancy promote glycogen deposition, supporting lactobacilli growth and maintaining this acidic pH. *4.5* - While 4.5 is **also within the normal range** (3.5-4.5) for pregnant women, it represents the **upper limit** of normal vaginal pH during pregnancy. - Although still physiologic, **4.0 is more commonly referenced** as the typical value in obstetric literature, making it the best answer for "typical" pH. - A pH consistently at 4.5 or trending upward may warrant monitoring, though it is not necessarily pathological. *5* - A pH of 5 is considered **elevated** and is typically associated with conditions like **bacterial vaginosis** (BV) or **trichomoniasis**, which increase the risk of preterm labor and other complications. - A pH of 5 in pregnancy would raise suspicion and warrant further investigation, as it indicates a **less acidic** environment and disruption of normal lactobacilli-dominated flora. - This elevated pH suggests loss of the protective acidic environment. *>5* - A pH greater than 5 is **abnormal** for a pregnant woman and strongly suggests the presence of a **vaginal infection**, such as bacterial vaginosis, trichomoniasis, or aerobic vaginitis. - This **alkaline shift** favors the growth of pathogenic bacteria over beneficial lactobacilli, significantly increasing the risk of adverse pregnancy outcomes including preterm birth and chorioamnionitis. - Requires prompt evaluation and treatment.

Question 1

Palmer sign is related to ?

Accepted Answer

Uterine contractions palpable through rectum during labor

Answer

Increased pulsations in uterine arteries

Answer

Bluish discoloration of cervix and vagina

Answer

Softening of the cervix during pregnancy

Question 2

Gold standard technique for diagnosis of endometriosis?

Accepted Answer

Laparoscopy

Answer

Ca 125 level

Answer

Ultrasound

Answer

MRI

Question 3

Which of the following statements about Asherman's syndrome is true?

Accepted Answer

Characterized by intrauterine adhesions

Answer

May be secondary to TB

Answer

Progesterone challenge test is positive

Answer

Not associated with menstrual irregularities

Question 4

What is the investigation of choice in postmenopausal bleeding?

Accepted Answer

Ultrasound

Answer

PAP smear

Answer

Laparoscopy

Answer

Fractional curettage

Question 5

Which structure is least likely to be injured during common gynecological procedures?

Accepted Answer

Renal pelvis

Answer

Ureter at pelvic brim

Answer

Urinary bladder

Answer

Ureter at infundibulopelvic ligament

Question 6

Which fetal presentation is the rarest?

Accepted Answer

Shoulder

Answer

Cephalic

Answer

Breech

Answer

Face

Question 7

Vaginal pH before puberty is?

Accepted Answer

Neutral (around 7)

Answer

Approximately 6

Answer

Approximately 4.5

Answer

Approximately 5

Question 8

What is the treatment for uterine prolapse in nulliparous women?

Accepted Answer

Manchester operation

Answer

Anterior colporrhaphy

Answer

Posterior colporrhaphy

Answer

Sling used involving rectus sheath

Question 9

Nuchal translucency is used in

Accepted Answer

ANC USG

Answer

Head scan

Answer

MRI neck

Answer

Anthropometry

Question 10

What is the typical pH of the vagina in a pregnant woman?

Accepted Answer

4.0

Answer

4.5

Answer

5

Answer

>5

NEET-PG 2012 — Obstetrics and Gynecology