Which among the following is an absolute contraindication of Hormone replacement therapy?
Which vaccine is contraindicated in pregnancy?
Which of the following is a method of natural family planning that involves tracking basal body temperature?
Which of the following is classified as a third generation Intrauterine Contraceptive Device (IUCD)?
Copper T is ideally inserted at-
Which of the following methods is used for prenatal diagnosis of Down Syndrome?
34 week primigravida punjabi khatri comes with history of consanguineous marriage, with history of repeated blood transfusion to her sibling since 8 months of age. The first diagnostic test is -
USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
Which type of pelvis is most commonly associated with dystocia?
All are true about constriction rings except which of the following?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 11: Which among the following is an absolute contraindication of Hormone replacement therapy?
- A. Endometriosis
- B. Heart disease
- C. Breast carcinoma (Correct Answer)
- D. Osteoarthritis
Explanation: ### Breast carcinoma - Hormone replacement therapy (HRT) is **contraindicated** in breast carcinoma because many breast cancers are **estrogen-receptor positive**, meaning estrogen can stimulate their growth [1]. - Using HRT in patients with a history of breast cancer significantly increases the risk of **recurrence** or **progression** of the disease [1]. *Endometriosis* - Endometriosis is not an **absolute contraindication**; HRT can sometimes be used in women with a history of endometriosis, especially if a hysterectomy and bilateral oophorectomy have been performed. - However, unopposed estrogen therapy might **exacerbate** remaining endometrial implants, so a combined estrogen-progestin regimen is typically preferred [1]. *Heart disease* - While HRT has been shown to have **risks** in women with established coronary heart disease, it is not an absolute contraindication for all forms of heart disease. - The **Women's Health Initiative study** demonstrated increased cardiovascular events in older women initiating HRT, but current guidelines suggest that timing of initiation is crucial and benefits may outweigh risks for younger postmenopausal women. *Osteoarthritis* - Osteoarthritis is **not a contraindication** to HRT; in fact, some studies suggest that estrogen may have protective effects on cartilage [2]. - HRT is neither a treatment nor a contraindication for osteoarthritis and does not significantly impact its progression or severity [2].
Question 12: Which vaccine is contraindicated in pregnancy?
- A. Cholera vaccine
- B. Typhoid vaccine
- C. Meningococcal vaccine
- D. Measles vaccine (Correct Answer)
Explanation: ***Measles vaccine*** - The measles vaccine is a **live attenuated vaccine**, which carries a theoretical risk of causing infection in the fetus. - Live vaccines are generally **contraindicated during pregnancy** due to this potential risk of congenital infection. *Cholera vaccine* - The cholera vaccine is generally considered **safe during pregnancy** if indicated, especially for travel to endemic areas. - While administration in pregnancy should be based on risk-benefit, it is not consistently contraindicated like live vaccines. *Typhoid vaccine* - Both inactivated and live attenuated typhoid vaccines are available; the **inactivated (killed) vaccine** is generally preferred if vaccination is necessary during pregnancy. - The risks of the disease usually outweigh the vaccine risks, and it is not a universal contraindication. *Meningococcal vaccine* - **Meningococcal vaccines** are generally considered safe and can be administered during pregnancy if there is a significant risk of exposure or during outbreaks. - The benefits of maternal and potential fetal protection from meningococcal disease outweigh theoretical risks.
Question 13: Which of the following is a method of natural family planning that involves tracking basal body temperature?
- A. Coitus interruptus (withdrawal method)
- B. Safe period (calendar method)
- C. Basal body temperature (BBT) method (Correct Answer)
- D. Abstinence (not having sexual intercourse)
Explanation: ***Basal body temperature (BBT) method*** - The **basal body temperature** (BBT) method relies on a slight increase in a woman's resting body temperature, typically by 0.5 to 1.0°F, occurring after **ovulation**. - This temperature shift signals that ovulation has occurred, allowing couples to identify the **fertile window** and avoid intercourse during that time. - This method involves tracking daily basal body temperature to predict ovulation. *Coitus interruptus (withdrawal method)* - This method involves the male withdrawing his penis from the vagina just before **ejaculation**. - It does not involve tracking **basal body temperature** and has a higher failure rate compared to many other contraceptive methods due to potential pre-ejaculatory fluid containing sperm. *Safe period (calendar method)* - The calendar method, also known as the **rhythm method** or **Ogino-Knaus method**, estimates the fertile window based on the typical length of a woman's menstrual cycles. - This method relies on calculating the approximate times of ovulation and avoiding intercourse during those days; it does not involve daily **temperature tracking**. *Abstinence (not having sexual intercourse)* - **Abstinence** involves completely refraining from sexual intercourse and is the only 100% effective method of preventing pregnancy and sexually transmitted infections (STIs). - This method does not involve any form of physical tracking, such as **basal body temperature**, as there is no risk of conception.
Question 14: Which of the following is classified as a third generation Intrauterine Contraceptive Device (IUCD)?
- A. Mirena (Correct Answer)
- B. Nova-T
- C. Lippe's loop
- D. CuT-200
Explanation: ***Mirena*** - Mirena (levonorgestrel-releasing intrauterine system) is a **third-generation IUCD** that releases **progestin**, offering both contraceptive and therapeutic benefits. - Its mechanism of action involves **thickening cervical mucus**, thinning the uterine lining, and inhibiting sperm motility/viability. *Nova-T* - Nova-T is a **second-generation IUCD** that uses **copper** as its active contraceptive agent. - Copper IUCDs like Nova-T primarily work by causing a **sterile inflammatory reaction** in the uterus, making it spermicidal. *Lippe's loop* - Lippe's loop is a **first-generation IUCD** made of inert plastic, designed to **physically block** fertilization. - It is no longer widely used due to higher rates of expulsion and complications compared to newer generations. *CuT-200* - CuT-200 is a **second-generation IUCD** that releases **copper** to prevent pregnancy. - It works by producing a **local inflammatory response** in the uterus that is toxic to sperm and eggs.
Question 15: Copper T is ideally inserted at-
- A. Just before menstruation
- B. On the 26th day
- C. Just after menstruation (Correct Answer)
- D. On the 14th day
Explanation: ***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.
Question 16: Which of the following methods is used for prenatal diagnosis of Down Syndrome?
- A. Karyotyping for chromosomal analysis (Correct Answer)
- B. Non-invasive prenatal testing (NIPT) for cell-free DNA analysis
- C. Triple test for biomarker screening
- D. Fetal ultrasonography for physical feature assessment
Explanation: ***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.
Question 17: 34 week primigravida punjabi khatri comes with history of consanguineous marriage, with history of repeated blood transfusion to her sibling since 8 months of age. The first diagnostic test is -
- A. HPLC
- B. Bone marrow
- C. Blood smear
- D. Hb electrophoresis (Correct Answer)
Explanation: ***Hb electrophoresis*** - The patient's history of **consanguineous marriage**, a sibling requiring **repeated blood transfusions** since 8 months of age, and Punjabi Khatri ethnicity strongly suggest a **hemoglobinopathy**, likely **beta-thalassemia major or intermedia**. - **Hemoglobin electrophoresis** is the traditional gold standard for definitive diagnosis of various hemoglobin variants and thalassemia types, identifying and characterizing abnormal hemoglobin patterns (e.g., elevated HbF, HbA2). - It remains a primary diagnostic test for hemoglobinopathies, particularly useful for pattern recognition of various thalassemia syndromes. *HPLC* - **High-performance liquid chromatography (HPLC)** is an equally valid and increasingly preferred method for diagnosing hemoglobinopathies, offering automated, precise quantification of hemoglobin fractions (HbA, HbA2, HbF). - In modern practice, HPLC is often used as a first-line screening tool due to its accuracy, reproducibility, and ability to provide quantitative data crucial for thalassemia diagnosis. - Both HPLC and Hb electrophoresis are acceptable diagnostic approaches; the choice between them depends on laboratory availability and practice patterns. For this 2013 exam, Hb electrophoresis was considered the traditional first diagnostic test. *Blood smear* - A **peripheral blood smear** would show morphological changes like **microcytic hypochromic red blood cells**, **target cells**, **anisopoikilocytosis**, and **nucleated RBCs**, which are suggestive of thalassemia. - These findings are indicative but non-specific and require confirmatory tests like hemoglobin electrophoresis or HPLC to identify the specific hemoglobin disorder and establish a definitive diagnosis. *Bone marrow* - A **bone marrow** examination would show **erythroid hyperplasia** due to increased ineffective erythropoiesis in thalassemia but is an invasive procedure and not the initial diagnostic test for hemoglobinopathies. - It provides details about cellularity and maturation but does not directly identify hemoglobin abnormalities, making it unsuitable as the first diagnostic step in suspected hemoglobinopathies.
Question 18: USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
- A. Renal pathway obstruction (Correct Answer)
- B. Neuromuscular disorder
- C. Gastrointestinal obstruction
- D. Anencephaly
Explanation: ***Renal pathway obstruction*** - **Oligohydramnios** (low amniotic fluid) in the late second or third trimester is often caused by conditions that impair fetal urine production or outflow. - **Renal pathway obstruction** (e.g., posterior urethral valves, bilateral renal agenesis) prevents the fetus from producing or excreting sufficient urine, a primary source of amniotic fluid. *Gastrointestinal obstruction* - **Gastrointestinal obstruction** is more commonly associated with **polyhydramnios** because it impairs the fetal swallowing of amniotic fluid. - Inability to swallow leads to an *accumulation* of amniotic fluid, not a reduction. *Anencephaly* - **Anencephaly** is typically associated with **polyhydramnios** due to impaired swallowing of amniotic fluid. - The exposed brain tissue can also lead to increased fluid transudation. *Neuromuscular disorder* - **Neuromuscular disorders** can cause **polyhydramnios** if they lead to impaired fetal swallowing due to muscle weakness. - If a neuromuscular disorder affects the renal system, it could potentially cause oligohydramnios, but it is not the primary cause of oligohydramnios itself.
Question 19: Which type of pelvis is most commonly associated with dystocia?
- A. Android (Correct Answer)
- B. Platypelloid
- C. Gynaecoid
- D. Anthropoid
Explanation: ***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.
Question 20: All are true about constriction rings except which of the following?
- A. Can be caused by excessive use of oxytocin.
- B. Also known as Schroeder's ring. (Correct Answer)
- C. Ring can be palpated per abdomen
- D. Inhalation of amyl nitrate can relax the ring.
Explanation: ***Also known as Schroeder's ring.*** - This statement is **INCORRECT** and is the correct answer to this "except" question. - **Schroeder's ring** is NOT synonymous with constriction rings. Schroeder's ring is a **physiological retraction ring** at the junction of the upper and lower uterine segments, which is a normal finding. - **Constriction rings** are **pathological, localized spastic contractions** of the uterine muscle at any level, causing obstruction to fetal descent. They differ from Bandl's pathological retraction ring. *Can be caused by excessive use of oxytocin.* - **Excessive oxytocin** can lead to **uterine hyperstimulation** and **incoordinate uterine contractions**, which may result in the formation of constriction rings. - This is a known iatrogenic cause of pathological constriction rings during labor. *Ring can be palpated per abdomen* - **Constriction rings** can sometimes be palpated as a **depression or groove** on the uterine surface during abdominal examination when they are well-developed. - They present as localized areas of myometrial spasm that may be clinically detectable. *Inhalation of amyl nitrate can relax the ring.* - **Amyl nitrite** (or amyl nitrate) is a **smooth muscle relaxant** that can be used to relax uterine constriction rings. - It acts as a **vasodilator** and **uterine relaxant**, temporarily relieving the spastic contraction to facilitate delivery or manual manipulation.