NEET-PG 2015 Practice Questions

Q: Which of the following conditions is most commonly associated with malodorous vaginal discharge?

Bacterial vaginosis. ***Bacterial vaginosis*** - This condition is characterized by a "fishy" or **malodorous vaginal discharge**, particularly noticeable after intercourse due to the release of amines. - It results from an imbalance in the vaginal flora, with an overgrowth of anaerobic bacteria and a decrease in protective lactobacilli. *Chlamydia trachomatis* - Often presents with **asymptomatic cervicitis** or mild watery discharge; **malodorous discharge** is not a common or prominent symptom. - While it can cause pelvic pain or dysuria, it's not typically associated with the characteristic smell of bacterial vaginosis. *Trichomonas vaginalis* - Can cause a **frothy, yellow-green discharge** that may be malodorous, but the "fishy" odor is more classically associated with bacterial vaginosis. - Other common symptoms include intense itching, burning, and dyspareunia. *Neisseria gonorrhoeae* - Causes cervicitis, which can lead to a **purulent or mucopurulent vaginal discharge**, but it does not typically produce the distinctive malodor seen in bacterial vaginosis. - Infection can also manifest as dysuria, pelvic pain, or be asymptomatic.

Q: Which of the following statements is true regarding placental site trophoblastic disease?

It secretes human placental lactogen. ***It secretes human placental lactogen*** - Placental site trophoblastic tumor (PSTT) characteristically consists of intermediate trophoblasts which secrete **human placental lactogen (hPL)**. - Unlike choriocarcinoma, PSTT secretes relatively low levels of **human chorionic gonadotropin (hCG)**. *Has a highly malignant potential* - PSTT generally has a **good prognosis** if the disease is confined to the uterus, with a survival rate of over 95%. - It has a low metastatic potential compared to choriocarcinoma, with metastases occurring in only about 15% of cases. *Mainly contains syncytiotrophoblasts* - PSTT is composed predominantly of **intermediate trophoblasts** that infiltrate the myometrium, rather than syncytiotrophoblasts or cytotrophoblasts. - The distinctive feature is the proliferation of these intermediate trophoblasts at the implantation site. *The treatment of choice is hysterectomy followed by chemotherapy* - **Hysterectomy** is generally the primary treatment for PSTT confined to the uterus, and it often cures the disease. - **Chemotherapy** is usually reserved for metastatic or recurrent disease, or in cases of extensive local invasion, and is not a routine follow-up after an uncomplicated hysterectomy.

Q: What does the term 'crowning' refer to in the context of childbirth?

Biparietal diameter at the vulval outlet. ***Biparietal diameter at the vulval outlet*** - **Crowning** specifically refers to the moment when the largest diameter of the baby's head (the **biparietal diameter**) has passed through the pelvic outlet and becomes visible at the vaginal opening without receding between contractions. - This signifies that the head is fully engaged and will no longer slip back, making birth imminent. *Biparietal diameter at the inlet of pelvis* - The **biparietal diameter** at the inlet of the pelvis describes the initial engagement of the fetal head into the pelvis, which is a much earlier stage than crowning. - This stage is referred to as **engagement**, not crowning, and there is no visible head at this point. *Biparietal diameter at the ischial spine* - The **ischial spines** are a landmark often used to assess the fetal head's station in the pelvis (how far down it has descended). - While important for assessing progress, the biparietal diameter reaching the ischial spines indicates a **station 0**, which is still internal and not visible at the vulva, thus not crowning. *Biparietal diameter just outside the vulval outlet* - If the **biparietal diameter** is **just outside** the vulval outlet, it implies the head has already been born or is so far progressed that crowning has already occurred or the head is delivering. - Crowning specifically describes the moment it becomes visible and sustained at the outlet, not outside it.

Q: Which of the following conditions can lead to a prolonged second stage of labor?

All of the options. ***All of the options*** - **Uterine inertia**, **maternal exhaustion**, and **cephalopelvic disproportion** are all well-established causes of a prolonged second stage of labor. - These factors either impede effective uterine contractions, reduce the mother's ability to push, or create a physical barrier to fetal descent, respectively. *Uterine inertia* - Refers to **weak** or **ineffective uterine contractions** that are insufficient to expel the fetus. - This directly prolongs the second stage by failing to provide adequate propulsive force. *Maternal exhaustion* - Occurs when the mother becomes too **tired** to effectively push, often due to a long and difficult labor. - Reduced maternal effort leads to a lack of downward pressure, extending the second stage. *Cephalopelvic disproportion* - Characterized by a mismatch between the **size of the fetal head** and the **maternal pelvis**, preventing the head from descending. - This mechanical obstruction inevitably leads to a prolonged, and often ultimately arrested, second stage of labor.

Q: Lovset manoeuvre is used in delivery of:

Arms. ***Arms*** - The Lovset manoeuvre is specifically designed to facilitate the delivery of the **shoulders and arms** in a **breech presentation** when they are extended upwards. - This technique involves rotating the fetal trunk to bring the anterior shoulder under the pubic symphysis, allowing for the gentle extraction of the posterior arm first, followed by the anterior arm. *Head* - Delivery of the head in a breech presentation is typically managed using **Mauriceau-Smellie-Veit manoeuvre** or Piper forceps, not the Lovset manoeuvre. - The Lovset manoeuvre aims to address difficult arm delivery prior to head delivery. *Breech* - While the Lovset manoeuvre is used *during* a breech delivery, it specifically addresses **arm extraction**, not the overall delivery of the entire breech presentation. - The term "breech" refers to the fetal presentation where the buttocks or feet are presented first. *Foot* - If a foot is presenting first, it is usually a **footling breech presentation**, and the delivery of the foot itself does not typically require the Lovset manoeuvre. - The Lovset manoeuvre is reserved for extended arms, which are distinct from the initial presentation of a foot.

Q: Common misdiagnosis of partial mole is

Threatened abortion. ***Threatened abortion*** - Partial moles often present with **vaginal bleeding** and a uterus size appropriate for gestational age, mimicking the symptoms of a **threatened abortion**. - **Fetal heartbeat** may be detectable in a partial mole, further complicating differentiation from a threatened abortion without detailed ultrasound or histological examination. *Choriocarcinoma* - **Choriocarcinoma** is a malignant tumor and a complication of molar pregnancy, not a common misdiagnosis of an early partial mole. - While both involve abnormal trophoblastic tissue, **choriocarcinoma** follows a molar pregnancy (or other gestations) and presents with systemic symptoms and very high hCG levels, distinct from the initial presentation of a partial mole. *Complete mole* - **Complete moles** are distinct from partial moles both genetically (46,XX or 46,XY with paternal origin only) and pathologically (no fetal tissue, generalized hydropic villi). - While both are types of molar pregnancy, they have different management and prognostic implications, and are distinct entities rather than a misdiagnosis of one for the other's initial presentation. *Ectopic pregnancy* - An **ectopic pregnancy** typically presents with pain and vaginal bleeding, along with an empty uterus on ultrasound. - While both involve abnormal pregnancy presentations, a **partial mole** usually shows some fetal tissue or identifiable placental tissue within the uterine cavity, distinguishing it from an ectopic pregnancy.

Q: When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?

Forceps may be applied if necessary.. ***Forceps may be applied if necessary.*** - At **station +2**, the fetal head has progressed significantly into the pelvis (2 cm below the ischial spines), indicating a **low-lying head** where instrumental delivery with **forceps** or a **vacuum extractor** can be safely performed if indicated (e.g., maternal exhaustion, fetal distress). - This station qualifies as **low forceps** or **outlet forceps** delivery, which are considered safe procedures when properly indicated. - The fetal head at this level has reached or is approaching the **pelvic floor**, meeting the prerequisites for assisted vaginal delivery. *Crowning occurs at this stage.* - **Crowning** specifically refers to the stage when the largest diameter of the fetal head is visible at the **vaginal introitus** and does not recede between contractions. - This occurs at approximately **station +4 to +5**, not at station +2. - While station +2 indicates significant descent, the fetus must descend further before crowning occurs. *There is a risk of deep transverse arrest.* - **Deep transverse arrest** occurs when the fetal head fails to internally rotate from the transverse position to an occipito-anterior or occipito-posterior position. - This complication typically occurs at **station 0 to +1** (mid-pelvis level), not at station +2. - By the time the fetal head reaches station +2 and the pelvic floor, internal rotation should have already occurred. *Episiotomy must be performed at this station.* - **Episiotomy** is **not mandatory** at any particular fetal station. - It is a selective procedure performed when indicated, typically just before crowning (around station +3 to +4), to prevent severe perineal trauma or expedite delivery. - The decision is based on clinical factors like fetal size, maternal tissue quality, and risk of severe laceration—not solely on fetal station.

Q: Which is not a risk factor for gestational hypertension

Smoking. ***Smoking*** - **Smoking** paradoxically shows a *protective effect* against gestational hypertension and preeclampsia, making it the correct answer as it is NOT a risk factor for gestational hypertension. - This well-documented phenomenon may be related to smoking's vasodilatory effects and reduced production of anti-angiogenic factors. - However, smoking carries numerous other serious risks including **intrauterine growth restriction (IUGR)**, **placental abruption**, **preterm birth**, and **perinatal mortality**. *Primigravida* - **Primigravida** (first pregnancy) is a well-established risk factor for gestational hypertension and preeclampsia. - First-time exposure to paternal antigens and incomplete immune tolerance may contribute to this increased risk. - The risk decreases in subsequent pregnancies with the same partner. *Factor V Leiden mutation* - The **Factor V Leiden mutation** is the most common inherited thrombophilia and significantly increases the risk of gestational hypertension and preeclampsia. - This mutation causes resistance to activated protein C, leading to a hypercoagulable state that can impair placental perfusion. - Associated with increased risk of venous thromboembolism during pregnancy. *Low maternal age* - **Low maternal age** (adolescent pregnancy, <20 years) is actually a recognized *risk factor* for gestational hypertension. - Young mothers may have incomplete physical and cardiovascular maturity to handle pregnancy-related physiological changes. - Adolescent pregnancies are associated with higher rates of hypertensive disorders of pregnancy.

Q: Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

Median nerve. ***Median nerve*** - The **lunate bone** dislocates volarly into the **carpal tunnel**, directly compressing the median nerve which passes through this space. - This compression leads to symptoms typical of **carpal tunnel syndrome**, such as numbness and tingling in the thumb, index, middle, and radial half of the ring finger. *Ulnar* - The **ulnar nerve** passes outside the carpal tunnel, through Guyon's canal, and is therefore not typically affected by injuries within the carpal tunnel itself. - Compression of the ulnar nerve would result in symptoms in the little finger and ulnar half of the ring finger, which are not the primary symptoms associated with lunate dislocation. *Radial nerve* - The **radial nerve** primarily innervates the dorsal aspect of the hand and travels more superficially in the forearm, not through the carpal tunnel. - Injuries to the radial nerve usually result from fractures of the humerus or direct trauma to the forearm, not lunate dislocation. *Median & ulnar nerve* - While both nerves can be affected by severe, generalized trauma to the wrist, a classic lunate dislocation specifically targets the **median nerve** within the carpal tunnel. - Concurrent ulnar nerve involvement is less common and would suggest additional or more extensive injury beyond a simple lunate dislocation affecting the carpal tunnel.

Q: What is the progestogen of choice in emergency contraception?

Levonorgestrel. ***Correct Option: Levonorgestrel*** - **Levonorgestrel** is the **progestogen of choice** for **emergency contraception** (Plan B, morning-after pill) - It works by **inhibiting or delaying ovulation**, preventing fertilization - Also alters **cervical mucus** to prevent sperm penetration and may affect endometrial receptivity - WHO-recommended as **single dose (1.5 mg)** or two doses (0.75 mg each, 12 hours apart) - Most effective when taken **within 72 hours** of unprotected intercourse, preferably within 24 hours *Incorrect Option: Norethisterone* - **Norethisterone** is a progestogen used in **oral contraceptive pills** and for managing gynecological conditions (menorrhagia, endometriosis, dysmenorrhea) - While it has progestational effects, it is **not the first-line choice** for emergency contraception - Less effective than levonorgestrel for post-coital contraception *Incorrect Option: Medroxyprogesterone* - **Medroxyprogesterone acetate** is used as a **long-acting depot contraceptive** (Depo-Provera injection every 3 months) - Also used for hormone replacement therapy and treating endometrial hyperplasia - **Not suitable for emergency contraception** due to its formulation and mechanism of action *Incorrect Option: Oxytocin* - **Oxytocin** is a posterior pituitary hormone that causes **uterine contractions** during labor and **milk ejection** during breastfeeding - It has **no role in contraception** or preventing pregnancy - Used therapeutically for labor induction, postpartum hemorrhage prevention, and augmentation of labor

Question 1

Which of the following conditions is most commonly associated with malodorous vaginal discharge?

Accepted Answer

Bacterial vaginosis

Answer

Chlamydia trachomatis

Answer

Trichomonas vaginalis

Answer

Neisseria gonorrhoeae

Question 2

Which of the following statements is true regarding placental site trophoblastic disease?

Accepted Answer

It secretes human placental lactogen

Answer

Has a highly malignant potential

Answer

Mainly contains syncytiotrophoblasts

Answer

The treatment of choice is hysterectomy followed by chemotherapy

Question 3

What does the term 'crowning' refer to in the context of childbirth?

Accepted Answer

Biparietal diameter at the vulval outlet

Answer

Biparietal diameter at the inlet of pelvis

Answer

Biparietal diameter at the ischial spine

Answer

Biparietal diameter just outside the vulval outlet

Question 4

Which of the following conditions can lead to a prolonged second stage of labor?

Accepted Answer

All of the options

Answer

Cephalopelvic disproportion

Answer

Uterine inertia

Answer

Maternal exhaustion

Question 5

Lovset manoeuvre is used in delivery of:

Accepted Answer

Arms

Answer

Head

Answer

Breech

Answer

Foot

Question 6

Common misdiagnosis of partial mole is

Accepted Answer

Threatened abortion

Answer

Choriocarcinoma

Answer

Complete mole

Answer

Ectopic pregnancy

Question 7

When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?

Accepted Answer

Forceps may be applied if necessary.

Answer

Crowning occurs at this stage.

Answer

There is a risk of deep transverse arrest.

Answer

Episiotomy must be performed at this station.

Question 8

Which is not a risk factor for gestational hypertension

Accepted Answer

Smoking

Answer

Primigravida

Answer

Factor V Leiden mutation

Answer

Low maternal age

Question 9

Which nerve is primarily affected by lunate dislocation in the carpal tunnel?

Accepted Answer

Median nerve

Answer

Ulnar

Answer

Radial nerve

Answer

Median & ulnar nerve

Question 10

What is the progestogen of choice in emergency contraception?

Accepted Answer

Levonorgestrel

Answer

Norethisterone

Answer

Medroxyprogesterone

Answer

Oxytocin

NEET-PG 2015

Obstetrics and Gynecology

Orthopaedics

Pharmacology