NEET-PG 2012 Practice Questions

Q: What is the best method to diagnose an unruptured ectopic pregnancy?

USG. ***Correct Answer: USG*** - **Transvaginal ultrasound (TVS)** is the most common and effective method for diagnosing an unruptured ectopic pregnancy. It allows for visualization of a gestational sac outside the uterus or an adnexal mass. - In conjunction with **serum beta-hCG levels**, TVS helps to differentiate between an intrauterine pregnancy and an ectopic pregnancy, especially when hCG levels are above the discriminatory zone (typically 1500-2000 mIU/mL). - TVS has high sensitivity and specificity for detecting ectopic pregnancy and is **non-invasive**. *Incorrect: Endoscopy* - **Endoscopy** (such as laparoscopy) is a surgical procedure, primarily used for direct visualization and treatment of ectopic pregnancies, not for initial diagnosis. - It is *too invasive* for routine diagnostic purposes in an unruptured ectopic pregnancy. *Incorrect: UPT* - A **urine pregnancy test (UPT)** confirms pregnancy but *cannot determine the location* of the pregnancy. - A positive UPT only indicates the presence of **hCG**, which is elevated in both intrauterine and ectopic pregnancies. *Incorrect: Culdocentesis* - **Culdocentesis** involves aspirating fluid from the cul-de-sac and is used to detect the presence of *free blood* in the peritoneal cavity, indicating a **ruptured** ectopic pregnancy. - It is not useful for diagnosing an **unruptured ectopic pregnancy** and is largely replaced by ultrasound in modern practice.

Q: What is the initial drug of choice for ovarian cancer?

Cisplatin. ***Cisplatin*** - **Cisplatin** is a platinum-based chemotherapy drug that forms DNA adducts, leading to apoptosis and is a **first-line agent** for ovarian cancer. - Historically, it was the platinum agent of choice and is typically used in combination with a taxane (e.g., **paclitaxel**) for initial treatment of advanced disease. - **Note:** In current practice, **carboplatin** has largely replaced cisplatin as the preferred platinum agent due to better tolerability, less nephrotoxicity and neurotoxicity, and easier administration, while maintaining equivalent efficacy. - Among the options listed, **cisplatin remains the correct answer** as it is the only platinum-based first-line agent. *Doxorubicin* - **Doxorubicin** is an **anthracycline antibiotic** used in various cancers but is **not a first-line drug** for ovarian cancer. - It may be used in recurrent or platinum-resistant disease. - Its use is limited due to potential **cardiotoxicity**. *Ifosfamide* - **Ifosfamide** is an **alkylating agent** that is generally reserved for **recurrent** or refractory ovarian cancer. - It is associated with **hemorrhagic cystitis** (preventable with mesna) and neurotoxicity. - Not part of standard first-line treatment. *Methotrexate* - **Methotrexate** is an **antimetabolite** primarily used in other cancers like choriocarcinoma and is **not a standard treatment** for epithelial ovarian cancer. - It works by inhibiting dihydrofolate reductase, disrupting DNA synthesis. - Has no role in first-line ovarian cancer treatment.

Q: Preferred treatment for menorrhagia in reproductive age group?

OCPs. ***OCPs*** - **Combined oral contraceptives (OCPs)** are a common and effective first-line treatment for menorrhagia in reproductive-aged women, particularly when contraception is also desired. - They work by stabilizing the **endometrial lining**, reducing menstrual blood loss and regulating cycles. *NOVA T* - NOVA T is a type of **copper IUD (intrauterine device)**, which is known to potentially *increase* menstrual bleeding and dysmenorrhea, making it unsuitable for menorrhagia. - Its primary function is contraception, not the management of heavy menstrual bleeding. *Cu IUD* - The **copper intrauterine device (Cu IUD)** is generally contraindicated in women with menorrhagia because it can exacerbate heavy menstrual bleeding. - While an effective contraceptive, it does not offer therapeutic benefits for managing heavy periods. *Hysterectomy* - **Hysterectomy** is a surgical procedure for removing the uterus and is considered a definitive treatment for menorrhagia. - However, it is an **invasive procedure** with irreversible loss of fertility, typically reserved for severe cases where conservative treatments have failed or when other uterine pathology is present.

Q: Which condition is associated with exclusively fetal blood loss?

Vasa previa. ***Vasa previa*** - Vasa previa occurs when **fetal blood vessels** from the umbilical cord traverse the membranes over the cervical os, underneath the fetal presenting part. - Rupture of these unprotected vessels, which can happen during labor or membrane rupture, leads to **exclusively fetal blood loss**, posing a high risk of fetal exsanguination and death. *Placenta praevia* - This condition involves the **placenta implanting low** in the uterus, potentially covering the internal cervical os. - Bleeding in placenta previa is typically **maternal** in origin, resulting from the detachment of the placenta from the uterine wall as the cervix dilates. *Polyhydramnios* - Polyhydramnios is characterized by an **excessive amount of amniotic fluid**. - It is not directly associated with antepartum or intrapartum bleeding, but rather with conditions that affect fetal swallowing or urination, such as **fetal gastrointestinal anomalies** or maternal diabetes. *Oligohydramnios* - Oligohydramnios refers to an **insufficient amount of amniotic fluid**. - While it can be associated with various fetal and maternal complications, such as **renal agenesis** or premature rupture of membranes, it does not typically cause blood loss.

Q: In which gestational weeks is Hegar's sign typically observed?

6 to 10 weeks. ***6 to 10 weeks*** - **Hegar's sign** is a softening of the lower uterine segment, which is a probable sign of pregnancy detected during a **bimanual examination**. - This softening typically becomes noticeable and palpable between **6 and 10 weeks of gestation** due to increased vascularity and edema in the area. *10-14 weeks* - While the uterus continues to soften and enlarge, **Hegar's sign** is usually established earlier, making it less specific or prominent for confirmation in this later window. - At this stage, other signs of pregnancy, such as a **palpable fetal outline** or **fetal heart tones**, become more readily apparent. *14-18 weeks* - By this gestational period, the uterus is significantly larger and has risen out of the pelvic cavity, making the specific assessment of the **lower uterine segment's compressibility** as an isolated sign less relevant. - **Fetal movements** (quickening) may also be felt during this time, serving as a more direct indicator of pregnancy. *18-22 weeks* - At these later weeks, the uterus is distinctly enlarged, and much of the diagnosis relies on **fundal height assessment** and further monitoring of fetal development. - **Hegar's sign** is a very early sign of pregnancy and would not be used for confirmation in this advanced stage.

Q: What is the most reliable test to confirm ovulation after it has occurred?

Serum progesterone. ***Serum progesterone*** - A **serum progesterone level** of greater than **3 ng/mL (or 10 nmol/L)** in the mid-luteal phase (approximately 7 days after the presumed ovulation) reliably indicates that ovulation has occurred. - After ovulation, the **corpus luteum** forms and produces progesterone, causing a characteristic rise in its serum level. *Serum estrogen* - Estrogen levels **peak before ovulation** to trigger the LH surge and also rise during the luteal phase, but a single measurement is not a reliable indicator that ovulation has successfully occurred. - Estrogen levels can fluctuate due to various factors and do not directly confirm the **formation and function of a corpus luteum** as progesterone does. *Both serum estrogen and progesterone* - While both hormones are involved in the menstrual cycle, relying on both simultaneously for confirming *occurred* ovulation is not the most precise method. - A significant rise in **progesterone** *after* the presumed ovulatory event is the key reliable biomarker. *None of the options* - This option is incorrect because **serum progesterone** is a well-established and reliable test for confirming ovulation.

Q: The optimal timing for external cephalic version (ECV) is

36 weeks. ***36 weeks*** - At **36 weeks gestation**, there is still enough **amniotic fluid** and fetal size is not too large, which allows for successful manipulation. - This timing is particularly optimal for **multiparous women** according to **RCOG guidelines** (36-37 weeks). - This timing also minimizes the risk of **spontaneous reversion** back to a breech presentation before labor begins. - Balances adequate fetal maturity with sufficient uterine space for successful version. *34 weeks* - Performing an external cephalic version (ECV) at 34 weeks has a lower success rate and a higher chance of **spontaneous reversion** due to the smaller fetal size and relatively more amniotic fluid. - The chance of **spontaneous cephalic version** (natural turning) is still significant at this stage, making an earlier intervention potentially unnecessary. - Too early for routine ECV as many breech presentations spontaneously convert to cephalic before 36 weeks. *38 weeks* - By 38 weeks, the fetus is larger and there is proportionally less **amniotic fluid**, which makes successful external version more difficult and painful for the mother. - While **ACOG recommends 37-38 weeks**, the success rate decreases with advancing gestation due to reduced uterine space. - The risk of **uterine contractions** and iatrogenic induction of labor is higher at this gestation. *40 weeks* - At 40 weeks, the fetus is at term and much larger, occupying most of the uterine cavity, significantly reducing the chances of a successful external version. - The risk of complications such as **placental abruption**, **cord compression**, and premature labor is increased. - Success rates are markedly lower, making routine ECV at this stage generally not recommended.

Q: Green stick fracture is

Incomplete fracture. ***Incomplete fracture*** - A **greenstick fracture** is an **incomplete fracture** where the bone bends and cracks but does not break all the way through. - This type of fracture commonly occurs in children because their bones are more flexible and softer than adult bones. *Fracture in adults* - While adults can experience various types of fractures, a **greenstick fracture** is rare in adults due to their more rigid and brittle bones. - Adult bones tend to sustain **complete fractures** or other complex fracture patterns instead of bending partially. *Complete fracture* - A **complete fracture** denotes a break in the bone that severs it into two or more distinct pieces. - **Greenstick fractures** are by definition incomplete, meaning the bone is still partially intact. *Fracture spine* - A **spinal fracture** specifically refers to a break in one or more vertebrae in the spinal column. - While spinal fractures can be complete or incomplete, the term **greenstick fracture** is not typically used to describe fractures of the spine.

Q: Newborn can be given breast milk after how much time following normal delivery?

1 hour. ***1 hour*** - Initiating breastfeeding **within 1 hour** after a normal vaginal delivery is the **WHO and UNICEF recommended standard** for optimal newborn care. - This practice, often called the **"golden hour"**, allows the newborn to benefit from **colostrum** (rich in antibodies and nutrients), promotes **mother-infant bonding**, and helps stimulate **uterine contractions** to reduce postpartum hemorrhage. - Early initiation within this timeframe supports **successful establishment of breastfeeding** and improves exclusive breastfeeding rates. *Half hour* - While initiating breastfeeding within 30 minutes is **excellent and encouraged**, the standard guideline allows up to 1 hour. - Immediate or very early feeding (within 30 minutes) is ideal when mother and baby are stable, but the flexibility up to 1 hour accommodates immediate postpartum care needs. *2 hours* - Delaying breastfeeding until 2 hours post-delivery **exceeds the recommended window** and can lead to the infant becoming **less alert** and less interested in feeding. - This delay is associated with **lower rates of successful exclusive breastfeeding** and may impact milk supply establishment. *3 hours* - A 3-hour delay in initiating breastfeeding is **significantly beyond recommended guidelines** after a normal, uncomplicated delivery. - Such delays can contribute to **poor latch**, **infant fatigue**, increased **formula supplementation**, and may hinder **long-term breastfeeding success**.

Q: What is the most common complication of a felon?

Osteomyelitis. ***Osteomyelitis*** - A **felon** is a severe infection of the **distal pulp space** of the fingertip, which has numerous fibrous septa. - The tightly compartmentalized nature of this space can lead to increased pressure, compromising blood supply and facilitating the spread of infection to the underlying **phalanx bone**, causing **osteomyelitis**. *Subungual hematoma* - A **subungual hematoma** is a collection of blood under the nail, usually resulting from direct trauma. - It is not a complication of an infection like a felon, but rather a separate traumatic injury. *Infective arthritis* - **Infective arthritis** involves the joint space, typically resulting from direct inoculation, hematogenous spread, or spread from adjacent soft tissue infection. - While possible, it is less common for a felon to directly spread to the **distal interphalangeal joint** compared to the more immediate risk of bone involvement. *No complications* - A **felon** is a serious infection that, if left untreated, almost always leads to complications due to the unique anatomy of the fingertip pulp space. - The high pressure within the compartments of the distal pulp makes it prone to necrosis and spread of infection to adjacent structures.

Question 1

What is the best method to diagnose an unruptured ectopic pregnancy?

Accepted Answer

USG

Answer

Endoscopy

Answer

UPT

Answer

Culdocentesis

Question 2

What is the initial drug of choice for ovarian cancer?

Accepted Answer

Cisplatin

Answer

Doxorubicin

Answer

Ifosfamide

Answer

Methotrexate

Question 3

Preferred treatment for menorrhagia in reproductive age group?

Accepted Answer

OCPs

Answer

Cu IUD

Answer

Hysterectomy

Answer

NOVA T

Question 4

Which condition is associated with exclusively fetal blood loss?

Accepted Answer

Vasa previa

Answer

Placenta praevia

Answer

Polyhydramnios

Answer

Oligohydramnios

Question 5

In which gestational weeks is Hegar's sign typically observed?

Accepted Answer

6 to 10 weeks

Answer

10-14 weeks

Answer

14-18 weeks

Answer

18-22 weeks

Question 6

What is the most reliable test to confirm ovulation after it has occurred?

Accepted Answer

Serum progesterone

Answer

Serum estrogen

Answer

Both serum estrogen and progesterone

Answer

None of the options

Question 7

The optimal timing for external cephalic version (ECV) is

Accepted Answer

36 weeks

Answer

34 weeks

Answer

38 weeks

Answer

40 weeks

Question 8

Green stick fracture is

Accepted Answer

Incomplete fracture

Answer

Fracture in adults

Answer

Complete fracture

Answer

Fracture spine

Question 9

Newborn can be given breast milk after how much time following normal delivery?

Accepted Answer

1 hour

Answer

Half hour

Answer

2 hours

Answer

3 hours

Question 10

What is the most common complication of a felon?

Accepted Answer

Osteomyelitis

Answer

Subungual hematoma

Answer

Infective arthritis

Answer

No complications

NEET-PG 2012

Obstetrics and Gynecology

Orthopaedics

Pediatrics

Surgery