NEET-PG 2012 - Obstetrics and Gynecology Practice Questions

Q: Which of the following statements about cholestasis of pregnancy is false?

Most common cause of jaundice in pregnancy. ***Most common cause of jaundice in pregnancy*** - This statement is **FALSE** - while **intrahepatic cholestasis of pregnancy (ICP)** is the most common **pregnancy-specific** cause of jaundice, it is NOT the most common cause of jaundice overall in pregnancy. - **Viral hepatitis** (especially hepatitis A, B, and E) remains the **most common cause of jaundice in pregnancy** worldwide, accounting for approximately 40-50% of cases. - ICP accounts for about 20-25% of jaundice cases in pregnancy, making it the leading obstetric-specific cause but not the overall leading cause. *Bilirubin level >2mg%* - In ICP, **bilirubin levels** are typically **normal or only mildly elevated** (usually 10 μmol/L), not bilirubin. *Oestrogen is involved* - **TRUE** - Elevated **estrogen and progesterone levels** during pregnancy play a key role in ICP pathophysiology. - These hormones affect **hepatic bile salt transporters** (particularly BSEP and MDR3), leading to impaired bile secretion in genetically susceptible individuals. *Manifestations usually appear in last trimester* - **TRUE** - ICP typically presents in the **third trimester** (usually after 28 weeks), with **pruritus** as the predominant symptom. - Symptoms resolve within days to weeks after delivery, correlating with declining hormone levels.

Q: Which of the following cannot be treated by laparoscopy?

Genital prolapse. ***Genital prolapse*** - Among the options listed, **genital prolapse** is the condition LEAST suited for complete laparoscopic management, particularly in the context of this examination question. - While **laparoscopic sacrocolpopexy** and **sacral hysteropexy** exist for vault prolapse and uterine prolapse respectively, these procedures were less established at the time of this exam (2012) and require advanced laparoscopic skills. - Most cases of **genital prolapse**, especially complete pelvic organ prolapse, traditionally require **vaginal surgical approaches** or **open abdominal procedures** for comprehensive repair of multiple compartment defects. - The complex anatomical reconstruction needed for severe prolapse (anterior, posterior, and apical compartments) is more challenging via laparoscopy compared to the other listed conditions. *Non descent of uterus* - **Non-descent vaginal hysterectomy** can be performed with **laparoscopic assistance (LAVH/LDVH)** or as **total laparoscopic hysterectomy (TLH)**. - Laparoscopy facilitates dissection of uterine attachments, ligation of vessels, and removal of the uterus with minimal morbidity. *Ectopic pregnancy* - **Ectopic pregnancy** is a standard indication for laparoscopic surgery, performed routinely worldwide. - Procedures include **laparoscopic salpingectomy** (removal of affected tube) or **salpingostomy** (conservative surgery preserving the tube). - Offers advantages of minimal invasiveness, reduced recovery time, and excellent visualization. *Sterilization* - **Laparoscopic tubal sterilization** is one of the most common laparoscopic procedures performed. - Methods include application of **Filshie clips, Falope rings**, or **electrocautery** to occlude fallopian tubes. - Gold standard for permanent contraception with minimal morbidity.

Q: Classical cesarean section is specifically indicated in which of the following conditions?

Cervical cancer involving lower uterine segment. ***Cervical cancer involving lower uterine segment*** - A classical cesarean section, involving a **vertical incision into the upper uterine segment**, allows for delivery of the fetus without disturbing the cancerous cervix and lower uterine segment. - This approach minimizes the risk of **tumor dissemination** and excessive bleeding, which would be high with a low transverse incision. *Transverse lie with back down* - A **low transverse cesarean section** is generally preferred for a transverse lie presentation as it aligns better with the uterine architecture and is associated with fewer future uterine rupture risks. - A classical incision is typically reserved for extreme cases of transverse lie (e.g., morbidly obese patient making access difficult or fetal anomaly) or when the **lower uterine segment is not adequately formed**. *Placenta previa with anterior placenta accreta* - This condition typically necessitates a **low transverse cesarean section**, often combined with a **hysterectomy**, due to the abnormal placental adherence to the anterior lower uterine segment. - A classical incision would likely lead to **significant hemorrhage** and may not effectively manage the adherent placenta. *Previous two cesarean sections* - While a previous cesarean section increases the risk of uterine rupture in subsequent pregnancies, it does not automatically indicate a classical cesarean section for the third delivery. - A repeat **low transverse cesarean section** is usually performed as it carries a lower risk of rupture in future pregnancies compared to a classical incision scar.

Question 1

Which of the following statements about cholestasis of pregnancy is false?

Accepted Answer

Most common cause of jaundice in pregnancy

Answer

Bilirubin level >2mg%

Answer

Oestrogen is involved

Answer

Manifestations usually appear in last trimester

Question 2

Which of the following cannot be treated by laparoscopy?

Accepted Answer

Genital prolapse

Answer

Non descent of uterus

Answer

Ectopic pregnancy

Answer

Sterilization

Question 3

Classical cesarean section is specifically indicated in which of the following conditions?

Accepted Answer

Cervical cancer involving lower uterine segment

Answer

Transverse lie with back down

Answer

Placenta previa with anterior placenta accreta

Answer

Previous two cesarean sections

NEET-PG 2012 — Obstetrics and Gynecology