NEET-PG 2017 Practice Questions

Q: Transvaginal saline infusion sonographic evaluation shows:

Asherman's syndrome. ***Asherman's syndrome*** - The image shows **intracavitary adhesions** within the endometrial cavity, characterized by bridging bands or strands of tissue with an irregular endometrial surface, as indicated by the arrow. - These findings on **saline infusion sonography (SIS)** are highly suggestive of **Asherman's syndrome**, which involves the formation of intrauterine adhesions. *Submucous leiomyoma* - Submucous leiomyomas (submucosal fibroids) are fibroids that project into the endometrial cavity and typically appear as **well-defined, hypoechoic masses** that distort the cavity. - The image does not show a distinct mass but rather **irregular strands** and a distorted cavity indicative of adhesions, not a fibroid. *Cervical stenosis* - Cervical stenosis involves an **abnormal narrowing of the cervical canal**, which would be seen as an obstruction to fluid flow into the uterine cavity during SIS. - While the image shows fluid within the uterine cavity, the primary pathology is within the cavity itself, not merely an obstruction at the cervix. *PCOD* - **Polycystic ovary syndrome (PCOS)** is primarily an ovarian disorder characterized by **multiple small follicles** (cysts) in the ovaries and hormonal imbalances. - PCOS is not a condition diagnosed by evaluating the endometrial cavity for adhesions using saline infusion sonography.

Q: What is the best treatment for the condition shown below?

Hysteroscopic adhesiolysis. ***Hysteroscopic adhesiolysis*** - The image shows an **intrauterine synechia**, also known as an **Asherman syndrome** or uterine adhesion, which manifests as fibrous bands within the uterine cavity (indicated by the arrow). - **Hysteroscopic adhesiolysis** is the gold standard for treating intrauterine adhesions, involving the surgical removal of these adhesions under direct visualization to restore the uterine cavity's normal anatomy. *OCP* - **Oral contraceptive pills (OCPs)** are primarily used for contraception, managing menstrual irregularities, or hormonal therapy. - They do not address or resolve **intrauterine adhesions** causing conditions like Asherman syndrome. *Transvaginal hysterectomy* - A **transvaginal hysterectomy** involves the surgical removal of the entire uterus, which is an aggressive and irreversible procedure. - This is not an appropriate treatment for intrauterine adhesions, especially in patients who may desire future fertility. *Intrauterine hyaluronidase injection* - While hyaluronidase is an enzyme that breaks down hyaluronic acid and has been explored in various applications, its efficacy as a primary treatment for established **intrauterine adhesions** is not well-supported in clinical practice. - The **mechanical removal** of fibrous adhesions is typically required.

Q: A 25-year-old lady had tubal rupture due to ectopic pregnancy at 6 weeks. The most common site of rupture of ectopic pregnancy amongst the following is:

2. ***Option 2 (Ampulla)*** - The image shows the **ampulla** of the fallopian tube labeled with '2'. This is the **most common site** for ectopic pregnancies, accounting for approximately **80-90%** of all tubal ectopic pregnancies. - The ampulla is the widest and longest part of the fallopian tube, making it a frequent location for implantation outside the uterus. Despite being wider, rupture is common here due to the thin wall and progressive distension from the growing pregnancy. *Option 1 (Interstitial/Cornual)* - The image points to the **interstitial** (or cornual) portion of the fallopian tube, labeled '1'. This is the **least common site** for ectopic pregnancy, accounting for only **2-4%** of cases. - While rare, rupture here can be **catastrophic** due to proximity to the uterine blood supply and rich vascular anastomoses, leading to severe hemorrhage. *Option 3 (Isthmus)* - The image highlights the **isthmus** of the fallopian tube with '3'. Ectopic pregnancies in the isthmus account for approximately **12%** of cases. - Rupture in the isthmus typically occurs **earlier** (around 6-8 weeks) than in the ampulla due to its narrower lumen and thicker muscular wall, which limits its ability to accommodate the growing pregnancy. *Option 4 (Infundibulum/Fimbriae)* - The image points to the **infundibulum** and **fimbriae**, labeled '4'. Fimbrial ectopic pregnancies are **extremely rare**, accounting for less than **5%** of cases. - The fimbriae are involved in capturing the ovum after ovulation. Implantation here is uncommon and may result in fimbrial abortion rather than rupture.

Q: The image shows:

PUBS. **PUBS** - The image displays a procedure where a needle is inserted through the maternal abdomen and into the **umbilical cord blood vessel** of the fetus, which is characteristic of **Percutaneous Umbilical Blood Sampling (PUBS)**. - PUBS, also known as **cordocentesis**, is used to obtain fetal blood for diagnostic purposes, such as detecting chromosomal abnormalities, genetic disorders, or fetal infections. *Amniocentesis* - **Amniocentesis** involves sampling **amniotic fluid** from the sac surrounding the fetus, not directly from the umbilical cord. - The needle in amniocentesis typically targets the amniotic sac, while in the image, it clearly targets an umbilical vessel. *Chorionic villus sampling* - **Chorionic villus sampling (CVS)** involves obtaining tissue from the **placenta** (chorionic villi), either transabdominally or transcervically. - The image clearly shows the needle entering the umbilical cord, not the placental tissue. *Fetal scalp sampling* - **Fetal scalp sampling** is performed during labor to assess fetal well-being by analyzing **fetal blood pH** from a small incision on the fetal scalp. - This procedure is performed late in pregnancy during labor and involves accessing the fetal scalp via the cervix, which is distinct from the transabdominal umbilical cord access shown.

Q: According to the Caldwell-Moloy classification, which of the following pelvic types is the LEAST common in women?

Platypelloid. ***Platypelloid*** - The **platypelloid pelvis** is characterized by a **flattened oval inlet** with a short anteroposterior diameter and wide transverse diameter, making it the **least common** type in women at only **3-5%** prevalence. - This pelvis type poses significant **obstetric challenges** due to the reduced anteroposterior diameter, leading to difficulties in fetal head **engagement and descent** during labor. *Gynecoid* - The **gynecoid pelvis** is the **most common** type, found in approximately **50%** of women, and represents the **ideal pelvis for childbirth**. - It features a **round or slightly oval inlet** with wide sacrosciatic notch and subpubic angle, facilitating smooth **vaginal delivery**. *Anthropoid* - The **anthropoid pelvis** has an **oval inlet** that is longer in the **anteroposterior diameter** than the transverse, occurring in about **20-30%** of women. - This type can accommodate successful vaginal delivery, often with the fetus in an **occipitoposterior position** due to the elongated anteroposterior dimension. *Android* - The **android pelvis** is characterized by a **heart-shaped inlet** and **narrow subpubic angle**, found in approximately **20-30%** of female pelves. - It is associated with more **difficult labor** due to the narrow mid-pelvis and **convergent side walls**, which can impede fetal descent.

Q: Which of the following is correct about the placenta shown below? (Recent NEET Pattern 2016-17)

Battledore placenta. ***Battledore placenta*** - This image depicts a **marginal insertion of the umbilical cord** into the placenta, where the cord attaches to the edge rather than the center or a more central part of the placental disc. This is characteristic of a battledore placenta. - The name "battledore" refers to the resemblance of the placenta and cord to a **tennis racket (battledore)**, where the cord is the handle and the placenta is the head. *Velamentous cord insertion* - In velamentous insertion, the **umbilical vessels diverge in the membranes before reaching the placental disc**, making them unprotected. - In this image, the cord clearly inserts into the edge of the placenta, rather than having vessels spread out in the membranes. *Placental chorioangioma* - A placental chorioangioma is a **benign tumor of the placenta**, characterized by an abnormal proliferation of fetal vessels within the chorionic villi. - This condition is a **mass within the placenta** itself and is not depicted by an anomalous cord insertion pattern. *Circumvallate placenta* - A circumvallate placenta has a **thickened, rolled amnion and chorion** due to a fold of the fetal membranes on the fetal side limiting the expansion of the placenta. - This describes a **membrane abnormality** affecting the shape of the placenta, not directly related to the cord insertion site shown.

Q: What is the type of placenta previa shown below?

Type 4. ***Type 4*** - Type 4 placenta previa, also known as **complete or central placenta previa**, occurs when the **placenta completely covers the internal cervical os**. - This type necessitates a **cesarean section** delivery due to the complete obstruction of the birth canal. *Type 1* - Type 1 placenta previa, or **low-lying placenta**, means the placenta is in the lower uterine segment but **does not reach the cervical os**. - It often resolves by term as the uterus grows, potentially allowing a **vaginal delivery**. *Type 2* - Type 2 placenta previa, or **marginal placenta previa**, indicates the placental edge **reaches the internal cervical os** but does not cover it. - While a vaginal delivery might be possible, there's an increased risk of **hemorrhage**. *Type 3* - Type 3 placenta previa, or **partial placenta previa**, is where the placenta **partially covers the internal cervical os** but not completely. - This type also typically requires a **cesarean section** due to the obstruction.

Q: The image shows:

Rachitic pelvis. ***Rachitic pelvis*** - The image illustrates a **flattened anteroposterior diameter** and a **pronounced protrusion of the sacrum** into the pelvic cavity. - These features are characteristic of a rachitic pelvis, which results from **rickets** (vitamin D deficiency) in childhood, leading to softened bones and deformities due to gravitational and muscular forces. *Scoliotic pelvis* - A scoliotic pelvis would show **asymmetry** in the pelvic bones due to **lateral curvature of the spine**, which is not the primary symmetrical flattening seen here. - This condition involves a **twisting or rotation** of the pelvis, rather than the anteroposterior compression depicted. *Osteomalacic pelvis* - An osteomalacic pelvis, while also due to poor bone mineralization, typically presents with a **triradiate or trefoil shape** resulting from indentation of the acetabula and collapse of the sacrum into the pelvic canal, leading to a **heart-shaped inlet**. - While related to vitamin D deficiency, the specific deformation pattern in the image with characteristic flattening is more indicative of a rachitic pelvis from childhood rather than adult-onset osteomalacia. *Naegele pelvis* - A Naegele pelvis is an **obliquely contracted pelvis** characterized by **atrophy or absence of one sacral ala** and ankylosis of the corresponding sacroiliac joint. - This results in a highly asymmetrical, severely distorted pelvic inlet, which is distinct from the symmetrical flattening observed in the image.

Q: The following delivery is seen with which type of pelvis?

Anthropoid pelvis. ***Anthropoid pelvis*** - This image illustrates the typical presentation of an **anthropoid pelvis**, characterized by an **oval-shaped inlet** that is wider from front to back than side to side. - This pelvic shape often facilitates a persistent **occiput posterior (OP)** position of the fetal head, as seen in the superior image, due to the longer anteroposterior diameter. *Gynecoid pelvis* - The **gynecoid pelvis** is considered the classic female pelvis, with a **rounded, slightly oval inlet** and a well-suited shape for vaginal delivery, allowing for normal fetal rotation. - It does not typically result in the persistent occiput posterior presentation and the more anterior/posterior orientation of the fetal skull shown. *Android pelvis* - An **android pelvis** has a **heart-shaped inlet** and prominent ischial spines, making it less favorable for vaginal delivery, often requiring descent in an occiput posterior position but with a narrower subpubic arch. - This type of pelvis is associated with higher rates of C-sections due to potential for cephalopelvic disproportion, and the fetal head typically encounters more difficulty at the outlet. *Platypelloid pelvis* - The **platypelloid pelvis** is characterized by a **flattened oval inlet** with a wide transverse diameter and a short anteroposterior diameter, making it the least common and least favorable for vaginal delivery. - This shape often results in the fetal head entering in a transverse arrest position, rather than the anteroposterior orientation suggested by the image.

Question 1

Transvaginal saline infusion sonographic evaluation shows:

Accepted Answer

Asherman's syndrome

Answer

Submucous leiomyoma

Answer

Cervical stenosis

Answer

PCOD

Question 2

What is the best treatment for the condition shown below?

Accepted Answer

Hysteroscopic adhesiolysis

Answer

OCP

Answer

Transvaginal hysterectomy

Answer

Intrauterine hyaluronidase injection

Question 3

A 25-year-old lady had tubal rupture due to ectopic pregnancy at 6 weeks. The most common site of rupture of ectopic pregnancy amongst the following is:

Accepted Answer

2

Answer

1

Answer

3

Answer

4

Question 4

The image shows:

Accepted Answer

PUBS

Answer

Amniocentesis

Answer

Chorionic villus sampling

Answer

Fetal scalp sampling

Question 5

Which is incorrect about the presentation shown below?

Accepted Answer

Mark commonly seen with platypelloid pelvis

Answer

Associated with anencephaly

Answer

Head is partially extended

Answer

Vaginal delivery is possible

Question 6

According to the Caldwell-Moloy classification, which of the following pelvic types is the LEAST common in women?

Accepted Answer

Platypelloid

Answer

Gynecoid

Answer

Anthropoid

Answer

Android

Question 7

Which of the following is correct about the placenta shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Battledore placenta

Answer

Velamentous cord insertion

Answer

Placental chorioangioma

Answer

Circumvallate placenta

Question 8

What is the type of placenta previa shown below?

Accepted Answer

Type 4

Answer

Type 1

Answer

Type 2

Answer

Type 3

Question 9

The image shows:

Accepted Answer

Rachitic pelvis

Answer

Scoliotic pelvis

Answer

Osteomalacic pelvis

Answer

Naegele pelvis

Question 10

The following delivery is seen with which type of pelvis?

Accepted Answer

Anthropoid pelvis

Answer

Gynecoid pelvis

Answer

Android pelvis

Answer

Platypelloid pelvis

NEET-PG 2017

Obstetrics and Gynecology