NEET-PG 2017 - Obstetrics and Gynecology Practice Questions

Q: Which degree of obstetric anal sphincter injury is seen here?

Third degree. ***Third degree*** - The image shows a laceration involving the **anal sphincter complex** but the **anal epithelium** is intact. - This corresponds to a **third-degree** tear, where the external and/or internal anal sphincter is torn but the mucosa is preserved. *First degree* - This degree of tear involves only the **perineal skin** and **vaginal mucosa**, without affecting underlying fascia or muscle. - The image clearly shows involvement of the anal sphincter, which is beyond a first-degree tear. *Second degree* - This involves the **perineal muscles** but the **anal sphincter** is intact. - The image illustrates that the anal sphincter itself is torn, not just the perineal muscles superficial to it. *Fourth degree* - This is the most severe tear, involving the **anal sphincter complex** and extending through the **anal epithelium** (mucosa) into the lumen of the rectum. - In the depicted image, the anal epithelium appears to be intact, differentiating it from a fourth-degree injury.

Q: All are correct regarding the device shown here except:

Placed 6 cm anterior to posterior fontanelle. ***Placed 6 cm anterior to posterior fontanelle*** - This is the **incorrect statement** - proper vacuum cup placement should be approximately **3 cm anterior to the posterior fontanelle** at the flexion point of the fetal head. - Placing the cup **6 cm anterior** would be too far forward, increasing risk of **cup dislodgement**, **subgaleal hemorrhage**, and ineffective traction. *Should generate effective vacuum of 0.8 Kg / cm^2* - This is a **correct statement** - effective vacuum pressure should be between **0.6 to 0.8 kg/cm^2** (500-600 mmHg). - This pressure range ensures adequate suction for delivery while minimizing risk of **fetal scalp injury**. *Traction at right angles to the cup* - This is a **correct statement** - traction must be applied **perpendicular to the cup plane** for optimal force transmission. - This technique prevents **cup dislodgement** and ensures efficient pulling force along the **birth canal axis**. *Traction is released in between uterine contractions* - This is a **correct statement** - traction should be **released between contractions** to prevent excessive force and allow fetal head repositioning. - Continuous traction can cause **fetal trauma** and **cup dislodgement** due to sustained pressure without uterine support.

Q: Identify the STD. (Recent Neet Pattern 2016-17)

Chlamydia. ***Chlamydia*** - The image exhibits **cervicitis** with a visible **purulent exudate** and **cervical edema**, which is highly characteristic of **Chlamydia trachomatis** infection. - Given that Chlamydia is often **asymptomatic** or presents with non-specific symptoms, direct visualization of such changes on the cervix is a key diagnostic indicator in symptomatic cases. *Gonorrhea* - While gonorrhea can also cause cervicitis with purulent discharge, the specific appearance in the image with more pronounced **edema** and somewhat **friable cervix** is more classically associated with Chlamydia in many clinical presentations. - Differentiation often requires **laboratory testing** (e.g., NAAT) as visual signs can overlap, but the depicted features lean more towards Chlamydia. *Syphilis* - Syphilis is typically characterized by **chancres** (painless ulcers) in its primary stage, or rashes and condylomata lata in secondary syphilis, none of which are seen in this image. - The image shows inflammation and discharge, not ulcerative lesions. *Chancroid* - Chancroid is characterized by **painful genital ulcers** with a characteristic soft base and often associated with **buboes** (swollen lymph nodes). - The findings in the image—cervical inflammation and discharge—do not align with the typical presentation of chancroid.

Q: Which of the following is incorrect about the instrument shown below? (Recent Neet Pattern 2016-17)

Contraindicated in postpartum state. ***Contraindicated in postpartum state*** - The instrument shown is a **uterine sound**, used to measure the **depth of the uterine cavity**. It is **not contraindicated in the postpartum state**; in fact, it can be used cautiously to check for retained products of conception or assess the uterine cavity, keeping in mind the uterus is softer and more prone to perforation. - This statement is **INCORRECT**, making it the right answer to this question. *Used to determine uterine size* - A **uterine sound** is primarily used to measure the **length of the uterine cavity from the external os to the fundus**, which helps determine uterine size. - This measurement is crucial for procedures like **IUD insertion**, endometrial biopsy, and hysteroscopy. - This is a **CORRECT** statement about the uterine sound. *Passed till it meets resistance at the fundus* - The uterine sound is passed through the **cervical canal** until it gently touches the **fundus** (top) of the uterus. - The measurement is read from the marking on the instrument corresponding to the external cervical os, typically ranging from **6-8 cm** in normal uteri. - This is a **CORRECT** statement about the technique. *Malleable sound* - The image depicts a **uterine sound**, which is typically made of **malleable metal** (usually stainless steel). - Its malleability allows it to be bent or shaped to match the **curvature of the uterus** (anteversion/retroversion), reducing the risk of perforation and facilitating accurate measurement. - This is a **CORRECT** statement about the instrument.

Q: Identify the instrument:

Mucus sucker. ***Mucus sucker*** - The image displays a device with a **curved tip** and a connecting piece, characteristic of a mucus sucker used for aspirating secretions. - This instrument is commonly used in **neonates** and **infants** to clear the airway from mucus or amniotic fluid. *Rubin insufflation cannula* - A Rubin insufflation cannula is typically used for **uterotubal insufflation**, a procedure to test the patency of fallopian tubes. - It has a more rigid, straight design with a cone-shaped tip to seal the cervix, which is different from the curved tip shown. *Uterine sound* - A uterine sound is a malleable, slender instrument used to **measure the depth and direction** of the uterine cavity. - Its design is typically straight or slightly curved, but lacks the suction port and associated components seen in the image. *Suction cannula* - While a mucus sucker is a type of suction cannula, a general suction cannula often refers to instruments like a **Yankauer suction tip** or **Frazier suction tip**. - These are typically used in different surgical fields with varied tip designs and sizes, and the specific instrument shown is clearly identifiable as a mucus sucker due to its characteristic shape for neonatal use.

Question 1

Which degree of obstetric anal sphincter injury is seen here?

Accepted Answer

Third degree

Answer

First degree

Answer

Second degree

Answer

Fourth degree

Question 2

All are correct regarding the device shown here except:

Accepted Answer

Placed 6 cm anterior to posterior fontanelle

Answer

Should generate effective vacuum of 0.8 Kg / cm^2

Answer

Traction at right angles to the cup

Answer

Traction is released in between uterine contractions

Question 3

Identify the STD. (Recent Neet Pattern 2016-17)

Accepted Answer

Chlamydia

Answer

Gonorrhea

Answer

Syphilis

Answer

Chancroid

Question 4

Which of the following is incorrect about the instrument shown below? (Recent Neet Pattern 2016-17)

Accepted Answer

Contraindicated in postpartum state

Answer

Used to determine uterine size

Answer

Passed till it meets resistance at the fundus

Answer

Malleable sound

Question 5

Identify the instrument:

Accepted Answer

Mucus sucker

Answer

Rubin insufflation cannula

Answer

Uterine sound

Answer

Suction cannula

NEET-PG 2017 — Obstetrics and Gynecology