NEET-PG 2013 - Obstetrics and Gynecology Practice Questions

Q: Copper T is ideally inserted at-

Just after menstruation. ***Just after menstruation*** - The **endometrium is thin** immediately after menstruation, making insertion easier and reducing the risk of pain and perforation. - Inserting it after menstruation also helps to ensure the woman is **not pregnant** at the time of insertion, as the uterus has shed its lining. *Just before menstruation* - The endometrium is typically **thicker and more vascular** just before menstruation, increasing the risk of bleeding and pain during insertion. - There is a higher possibility of **early pregnancy**, which would contraindicate IUD insertion. *On the 26th day* - The 26th day of the menstrual cycle is usually in the **luteal phase**, when the endometrium is highly vascularized and receptive, which could increase discomfort and bleeding during insertion. - This timing also carries a **higher risk of pregnancy**, making IUD insertion potentially hazardous if not confirmed otherwise. *On the 14th day* - The 14th day typically corresponds to the **ovulation period**, making it a high-risk time for conception if protection has not been used. - The uterus is also more sensitive during ovulation, potentially leading to increased discomfort or complications during insertion.

Q: Which of the following methods is used for prenatal diagnosis of Down Syndrome?

Karyotyping for chromosomal analysis. ***Karyotyping for chromosomal analysis*** - **Karyotyping** is the gold standard definitive diagnostic method for Down syndrome (trisomy 21) as it directly visualizes and counts all chromosomes, identifying the presence of an extra copy of chromosome 21. - This cytogenetic method provides a clear genetic diagnosis with 100% accuracy, confirming the chromosomal abnormality responsible for Down syndrome. - Karyotyping can be performed on cells obtained via amniocentesis or chorionic villus sampling (CVS). *Triple test for biomarker screening* - The **triple test** measures biochemical markers (alpha-fetoprotein, unconjugated estriol, and hCG) to assess the risk of Down syndrome, but it is a **screening tool**, not a diagnostic method. - It has a detection rate of approximately 69% with a 5% false-positive rate. - Abnormal results require confirmatory diagnostic testing with karyotyping or other chromosomal analysis methods. *Fetal ultrasonography for physical feature assessment* - Fetal ultrasonography can detect **soft markers** such as increased nuchal translucency, absent/hypoplastic nasal bone, echogenic intracardiac focus, or structural anomalies that raise suspicion for Down syndrome. - However, ultrasound findings are **not diagnostic** on their own and have limited sensitivity and specificity. - Positive findings necessitate genetic testing like karyotyping for definitive diagnosis. *Non-invasive prenatal testing (NIPT) for cell-free DNA analysis* - **NIPT** analyzes cell-free fetal DNA in maternal blood and has high sensitivity (>99%) and specificity (>99%) for detecting trisomy 21. - Despite its excellent screening performance, NIPT is still classified as a **screening test**, not a diagnostic test. - Positive NIPT results require confirmation with diagnostic testing (karyotyping) before making clinical decisions regarding the pregnancy.

Q: The 'T' sign is associated with which condition?

Monochorionic twin pregnancy. ***Monochorionic twin pregnancy*** - The **'T' sign** on ultrasound is highly suggestive of a **monochorionic twin pregnancy**, indicating shared placenta and a thin inter-twin membrane that meets the chorion at a sharp, T-shaped angle. - This sign identifies the absence of a chorionic plate extending into the inter-twin membrane, distinguishing it from thick-membraned dichorionic pregnancies. *Dichorionic twin pregnancy* - Dichorionic pregnancies typically exhibit the **'lambda' or 'twin peak' sign**, where the chorion extends into the inter-twin membrane, creating a triangular projection, not a 'T' shape. - This sign indicates two separate placentas (or fused but distinct placentas) and two chorions, leading to a thicker inter-twin membrane. *Normal singleton pregnancy* - A normal singleton pregnancy involves only one fetus, and therefore no inter-twin membrane or associated signs like the 'T' or 'lambda' sign are present. - The concept of chorionicity and amnionicity is specific to multiple gestations, particularly twin pregnancies. *Multiple gestation* - While a monochorionic twin pregnancy is a type of multiple gestation, the term "multiple gestation" is too broad and does not specifically identify the **'T' sign**. - Multiple gestation can be either monochorionic or dichorionic, and only monochorionic pregnancies are associated with the 'T' sign.

Q: For routine diagnostic purposes, endometrial biopsy is usually done at which phase of the menstrual cycle?

Just before menstruation. ***Just before menstruation*** - An endometrial biopsy is typically performed in the **late secretory phase (just before menstruation)**. This timing is crucial for evaluating the endometrial response to progesterone and for detecting abnormalities that may be evident during this phase. - This timing allows for the assessment of the **full development of the secretory glands** and stroma, which can reveal issues like **inadequate luteal phase** or **endometrial hyperplasia** more clearly. *10-12 days after menstruation* - This time point corresponds to the mid-proliferative phase, where the endometrium is still growing under **estrogen influence**. - While suitable for evaluating proliferative changes, it might **miss subtle secretory phase abnormalities** or early signs of hyperplasia that are more evident later. *Just after menstruation* - This period is the early proliferative phase, where the endometrium is **thin and regenerating**. - Biopsying at this time might yield insufficient tissue for comprehensive evaluation and would be too early to assess **hormonal responses** that occur later in the cycle. *At the time of ovulation* - Ovulation marks the transition from the proliferative to the secretory phase, influenced by a surge in **luteinizing hormone (LH)**. - An endometrial biopsy at this phase would primarily show a proliferative endometrium and would not provide adequate information about the **key features of the secretory phase**, which are important for diagnostic purposes related to fertility or abnormal bleeding.

Q: In which stage of cervical carcinoma is surgery performed to retain the possibility of conception?

Stage 1B1. ***Stage 1B1*** - In **Stage 1B1 cervical carcinoma** (FIGO 2018), the tumor size is **≤2 cm** and confined to the cervix, making it amenable to **fertility-sparing surgery** like radical trachelectomy. - This stage allows for removal of the cervix and parametrium while preserving the **uterine body** and ovaries, thus retaining the possibility of conception. - Strict selection criteria must be met including tumor size ≤2 cm, no lymphovascular space invasion, negative lymph nodes, and adequate follow-up compliance. *Stage 1B2* - **Stage 1B2** (FIGO 2018) involves tumors **>2 cm to ≤4 cm** but still confined to the cervix, which generally have a higher risk of recurrence and lymph node metastasis. - While fertility-sparing surgery might be considered in highly selective cases with tumors 2-3 cm, it is much less commonly performed than in Stage 1B1 due to the increased tumor burden and higher oncological risk. *Stage 2A* - In **Stage 2A cervical carcinoma**, the tumor has spread beyond the cervix to involve the upper two-thirds of the vagina (2A1: ≤4 cm, 2A2: >4 cm) but not the parametrium. - The disease extent typically necessitates more aggressive treatment such as radical hysterectomy or **chemoradiation**, precluding preservation of fertility in most cases. *Stage 2B* - **Stage 2B** involves tumor invasion into the **parametrium**, making fertility-sparing surgery contraindicated and typically requiring **definitive chemoradiation**. - The spread of cancer to the parametrium indicates a more advanced disease that cannot be adequately treated by methods that preserve fertility.

Q: Oligomenorrhoea means ?

Cycle longer than 35 days. ***Cycle longer than 35 days*** - **Oligomenorrhea** is defined by menstrual cycles that are **infrequently occurring**, specifically lasting longer than 35 days. - This condition is distinct from **amenorrhea**, which is the complete absence of menstruation. *Cycle < 20 days* - A menstrual cycle lasting less than 20 days is considered **polymenorrhea**, indicating abnormally frequent menstruation. - This is the opposite of oligomenorrhea, which refers to infrequent menstruation. *Cycle more than 45 days* - While a cycle longer than 45 days would technically fall under **oligomenorrhea**, the general definition begins at an interval longer than **35 days**. - Cycles significantly longer than 45 days might also point to **amenorrhea**, depending on the exact duration and pattern. *Cycle more than 28 days* - A cycle lasting more than 28 days is within the **normal range** for many individuals, as the average cycle length is 21-35 days. - Therefore, this duration alone does **not define oligomenorrhea**.

Q: In the context of obstructed labor, which maternal pelvic parameter is considered the most critical for successful delivery?

Diameter of pelvic inlet. ***Diameter of pelvic inlet*** - The **pelvic inlet** is typically the narrowest and most critical passage for the fetal head to engage and descend into the pelvis during labor. - An inadequate pelvic inlet diameter can lead to **cephalopelvic disproportion**, resulting in **obstructed labor** because the fetal head cannot enter the true pelvis. *Diameter of pelvic outlet* - While important for the final stages of labor, an inadequate **pelvic outlet** usually presents a problem only after the fetal head has successfully navigated the inlet and mid-pelvis. - Obstruction at the outlet is less common as the primary cause of prolonged or arrested first stage labor compared to an unyielding inlet. *Biparietal diameter* - The **biparietal diameter (BPD)** measures the widest transverse diameter of the fetal head, which is crucial but represents a fetal parameter. - While critical for assessing fetal head size in relation to the maternal pelvis, it is a fetal measurement, not a maternal pelvic parameter like the inlet. *Bitemporal diameter* - The **bitemporal diameter** is the shortest transverse diameter of the fetal head and is rarely the presenting issue in **obstructed labor**. - It is typically much smaller than the biparietal diameter and usually presents no obstacle to passage through the pelvis.

Q: Which type of pelvis is most commonly associated with dystocia?

Android. ***Android*** - The **android pelvis** has a **heart-shaped inlet** and converging side walls, which significantly increases the risk of **dystocia** due to restricted passage for the fetal head. - This pelvic shape is more common in men but can also be found in women, leading to a higher likelihood of **cephalopelvic disproportion**. *Platypelloid* - The **platypelloid pelvis** has a **flattened oval inlet** with a short anteroposterior diameter and a wide transverse diameter. - While it can lead to difficulties with engagement and rotation, it is not as commonly associated with severe dystocia as the android type, as the fetal head can often rotate to fit. *Gynaecoid* - The **gynaecoid pelvis** is considered the **ideal female pelvis** with a rounded or slightly oval inlet and well-proportioned diameters. - It is associated with the **easiest and most successful vaginal deliveries** and therefore is least likely to cause dystocia. *Anthropoid* - The **anthropoid pelvis** has an **oval inlet** with a long anteroposterior diameter and a relatively short transverse diameter. - While it can sometimes lead to an **occiput-posterior presentation**, it is not as strongly associated with dystocia as the android pelvis.

Q: What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?

Insufficient progesterone due to anovulation. ***Insufficient progesterone due to anovulation*** - Anovulation prevents the formation of a **corpus luteum**, which is responsible for producing progesterone. - The lack of progesterone leads to an **unstable, proliferative endometrium** that eventually sheds irregularly, causing abnormal uterine bleeding. - This is the **primary hormonal defect** in anovulatory DUB. *Excess estrogen production from ovarian follicles* - While **unopposed estrogen** is present in anovulatory cycles, the primary issue is the *absence of progesterone*, not necessarily excess estrogen production. - Estrogen levels may be normal or even low, but without progesterone to stabilize the endometrium, irregular shedding occurs. - Excess estrogen primarily leads to **endometrial hyperplasia** rather than irregular bleeding. *Hypothalamic dysfunction affecting ovulation* - Hypothalamic dysfunction (e.g., due to stress, extreme exercise) can be an *underlying cause* of anovulation. - However, the *primary hormonal mechanism* of the bleeding itself is the subsequent lack of progesterone, not the hypothalamic dysfunction directly. *High levels of progesterone due to luteal phase defect* - A **luteal phase defect** involves *insufficient* progesterone production or response, not high levels. - High progesterone levels would stabilize the endometrium and promote regular shedding, preventing DUB.

Q: What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?

Continuous OC pill. ***Continuous OC pill*** - For **mild endometriosis** in a young woman, **continuous oral contraceptive pills (OCP)** are the **first-line medical treatment** according to current evidence-based guidelines (ACOG, ESHRE). - Continuous OCP use provides better suppression of endometriosis by creating a **stable hormonal environment** that prevents cyclic menstrual bleeding and retrograde menstruation, which can worsen endometriosis. - This approach effectively manages symptoms like **dysmenorrhea** and **pelvic pain** while preserving future fertility, and is well-tolerated in young women with the added benefit of menstrual suppression. *Cyclical OC pill* - While cyclical OCPs can help manage endometriosis symptoms, they are **less effective** than continuous OCPs because they allow withdrawal bleeding, which may perpetuate retrograde menstruation and endometrial implant stimulation. - Cyclical OCPs may still provide symptom relief but are considered a **second-line option** when continuous use is not acceptable to the patient. *Progesterone only pill* - **Progesterone-only pills (POP)** can suppress endometriosis by inducing amenorrhea and decidualization of endometrial implants, but they may cause **irregular bleeding patterns**, especially in the first few months. - While effective, they are generally considered when combined OCPs are contraindicated (e.g., migraine with aura, thrombotic risk) rather than as first-line for uncomplicated mild endometriosis. *Danazole* - **Danazol** is an androgenic agent that creates a hypoestrogenic environment, leading to atrophy of endometrial tissue, but it is **rarely used today** due to significant androgenic side effects. - Common side effects include **acne**, **hirsutism**, **weight gain**, and **voice deepening**, which are often unacceptable for a 21-year-old woman, making it an obsolete option for first-line management of mild endometriosis.

Question 1

Copper T is ideally inserted at-

Accepted Answer

Just after menstruation

Answer

Just before menstruation

Answer

On the 26th day

Answer

On the 14th day

Question 2

Which of the following methods is used for prenatal diagnosis of Down Syndrome?

Accepted Answer

Karyotyping for chromosomal analysis

Answer

Non-invasive prenatal testing (NIPT) for cell-free DNA analysis

Answer

Triple test for biomarker screening

Answer

Fetal ultrasonography for physical feature assessment

Question 3

The 'T' sign is associated with which condition?

Accepted Answer

Monochorionic twin pregnancy

Answer

Dichorionic twin pregnancy

Answer

Normal singleton pregnancy

Answer

Multiple gestation

Question 4

For routine diagnostic purposes, endometrial biopsy is usually done at which phase of the menstrual cycle?

Accepted Answer

Just before menstruation

Answer

10-12 days after menstruation

Answer

Just after menstruation

Answer

At the time of ovulation

Question 5

In which stage of cervical carcinoma is surgery performed to retain the possibility of conception?

Accepted Answer

Stage 1B1

Answer

Stage 1B2

Answer

Stage 2A

Answer

Stage 2B

Question 6

Oligomenorrhoea means ?

Accepted Answer

Cycle longer than 35 days

Answer

Cycle < 20 days

Answer

Cycle more than 45 days

Answer

Cycle more than 28 days

Question 7

In the context of obstructed labor, which maternal pelvic parameter is considered the most critical for successful delivery?

Accepted Answer

Diameter of pelvic inlet

Answer

Biparietal diameter

Answer

Bitemporal diameter

Answer

Diameter of pelvic outlet

Question 8

Which type of pelvis is most commonly associated with dystocia?

Accepted Answer

Android

Answer

Platypelloid

Answer

Gynaecoid

Answer

Anthropoid

Question 9

What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?

Accepted Answer

Insufficient progesterone due to anovulation

Answer

Excess estrogen production from ovarian follicles

Answer

Hypothalamic dysfunction affecting ovulation

Answer

High levels of progesterone due to luteal phase defect

Question 10

What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?

Accepted Answer

Continuous OC pill

Answer

Cyclical OC pill

Answer

Progesterone only pill

Answer

Danazole

NEET-PG 2013 — Obstetrics and Gynecology