Ovarian reserve is best indicated by
What is Hegar's sign in obstetrics?
What does teratozoospermia refer to?
What percentage of women typically deliver on their Estimated Due Date (EDD)?
What is a potential risk for pregnant women who undertake long journeys with prolonged sitting?
What maneuver is used to deliver the head of a baby during a breech delivery?
What is the purpose of the Prague maneuver in obstetrics?
Commonest variety of compound presentation is?
What is the expected rate of turnover of amniotic fluid in a pregnant woman?
Which type of pelvis is most commonly associated with dystocia?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 21: Ovarian reserve is best indicated by
- A. Follicle-stimulating hormone (FSH)
- B. Anti-Müllerian Hormone (AMH) (Correct Answer)
- C. Luteinizing hormone (LH)
- D. LH/FSH ratio
Explanation: ***Anti-Müllerian Hormone (AMH)*** - **AMH is currently considered the best single biochemical marker** for assessing ovarian reserve - Produced by **granulosa cells of preantral and small antral follicles**, directly reflecting the size of the primordial follicle pool - **Cycle-independent** - can be measured at any time during the menstrual cycle - **More sensitive and specific** than FSH for detecting diminished ovarian reserve - **Minimal inter-cycle and intra-cycle variability**, providing consistent and reliable results - Widely used in **fertility assessment, IVF protocols**, and predicting ovarian response to stimulation *Follicle-stimulating hormone (FSH)* - Elevated **early follicular phase FSH** (measured on day 3) indicates diminished ovarian reserve - Historically the most commonly used marker, but **less sensitive than AMH** - **Cycle-dependent** - must be measured on specific days (day 2-4 of cycle) - A **late marker** - rises only when ovarian reserve is already significantly diminished - Still clinically useful and widely available, but not the "best" indicator *Luteinizing hormone (LH)* - **LH** primarily triggers ovulation and does not directly reflect ovarian reserve - Elevated in conditions like **PCOS** but does not assess the quantity or quality of remaining follicles - Not a reliable indicator of overall ovarian reserve *LH/FSH ratio* - An elevated **LH/FSH ratio** (>2:1 or >3:1) is associated with **Polycystic Ovary Syndrome (PCOS)** - Reflects anovulation and hormonal imbalance, not the number or viability of ovarian follicles - Does not assess ovarian reserve capacity
Question 22: What is Hegar's sign in obstetrics?
- A. Uterine contractions
- B. Fetal movement
- C. Cyanosis of the vagina
- D. Softening of the uterine isthmus (Correct Answer)
Explanation: ***Softening of the uterine isthmus*** - **Hegar's sign** is an early presumptive sign of pregnancy characterized by the **softening of the lower uterine segment (isthmus)**, which can be palpated during a bimanual examination. - This softening makes the fundus and cervix feel like separate entities, indicating increased vascularity and changes due to hormonal influence. *Uterine contractions* - While contractions do occur during pregnancy (e.g., **Braxton Hicks contractions**), they are not what defines Hegar's sign. - **Uterine contractions** are typically associated with labor or placental abruption, not the specific softening of the isthmus. *Fetal movement* - **Fetal movement** (quickening) is a positive sign of pregnancy perceived by the mother, usually after 16-20 weeks gestation. - This is entirely distinct from Hegar's sign, which is a physical finding upon examination of the uterus. *Cyanosis of the vagina* - **Cyanosis of the vagina** and cervix is known as **Chadwick's sign**, another presumptive sign of pregnancy. - Chadwick's sign is due to increased vascularity and venous congestion, causing a bluish discoloration, but it's not the softening described in Hegar's sign.
Question 23: What does teratozoospermia refer to?
- A. Low sperm count
- B. Sperm with abnormal motility
- C. Absence of sperm in semen
- D. Morphologically defective sperm (Correct Answer)
Explanation: ***Morphologically defective sperm*** - **Teratozoospermia** specifically refers to the presence of an unusually high percentage of **abnormally shaped sperm** in an ejaculate. - These malformations can affect the **head, midpiece, or tail** of the sperm, potentially impairing its ability to fertilize an egg. *Low sperm count* - This condition is known as **oligozoospermia**, which refers to a sperm concentration below the normal range. - While low sperm count can affect fertility, it is distinct from issues with sperm morphology. *Sperm with abnormal motility* - This condition is called **asthenozoospermia**, characterized by reduced or absent sperm movement. - Poor motility impacts the sperm's ability to reach and penetrate the egg, but it is not directly related to sperm shape. *Absence of sperm in semen* - The complete absence of sperm in the ejaculate is known as **azoospermia**. - This is a severe form of male infertility, different from having sperm with structural defects.
Question 24: What percentage of women typically deliver on their Estimated Due Date (EDD)?
- A. 15%
- B. 5% (Correct Answer)
- C. 20%
- D. 10%
Explanation: ***5%*** - Only about **5% of women** deliver on their **exact Estimated Due Date (EDD)**. - The EDD is calculated using **Naegele's rule** (280 days from LMP) and serves as an **approximation** rather than a precise prediction. - Most women deliver within a **37-42 week window**, with the majority occurring in the **2 weeks before or after** the EDD. - This reflects the **natural biological variation** in pregnancy duration. *10%* - This percentage is **higher than the actual rate** of delivery on the exact EDD. - While 10% might seem plausible for deliveries within a few days of the EDD, it overestimates delivery on that specific date. *15%* - This percentage **significantly overestimates** the likelihood of delivering precisely on the EDD. - The probability of birth on one specific day out of a several-week delivery window is relatively low. *20%* - This is a substantial **overestimation** of the probability of delivering on the EDD. - The EDD represents a **single day** in a term pregnancy window (37-42 weeks), making such a high percentage statistically unlikely.
Question 25: What is a potential risk for pregnant women who undertake long journeys with prolonged sitting?
- A. Venous thromboembolism
- B. Deep vein thrombosis (Correct Answer)
- C. Pulmonary embolism
- D. Leg swelling
Explanation: ***Deep vein thrombosis*** - **Pregnancy** is a **hypercoagulable state** due to increased levels of clotting factors (fibrinogen, factors VII, VIII, X) and decreased protein S activity. - **Prolonged sitting** during long journeys causes **venous stasis** in the lower extremities, which is a key component of **Virchow's triad** for thrombosis (stasis, hypercoagulability, endothelial injury). - **DVT** is the **direct and most specific pathological consequence** of prolonged immobilization during travel in pregnancy. - The risk of **VTE in pregnancy** is **4-5 times higher** than in non-pregnant women, with travel-related DVT being a recognized complication. *Venous thromboembolism* - VTE is an **umbrella term** that encompasses both **DVT and pulmonary embolism**. - While technically correct as a broader category, DVT is the **more specific and direct answer** to what prolonged sitting causes. - In medical education and clinical practice, identifying the **specific pathology** (DVT) is more appropriate than using the general category (VTE). *Pulmonary embolism* - PE is a **complication** of DVT, occurring when a thrombus dislodges and embolizes to the pulmonary circulation. - PE is a **secondary consequence**, not the **primary risk** from prolonged sitting itself. - The direct mechanism of prolonged sitting → venous stasis → **DVT formation** → potential embolization to lungs. *Leg swelling* - **Leg swelling** (edema) is a **symptom**, not a pathological diagnosis. - While leg edema can indicate DVT, it's also common in normal pregnancy due to increased venous pressure and fluid retention. - The question asks for a **risk** (pathological condition), not a symptom.
Question 26: What maneuver is used to deliver the head of a baby during a breech delivery?
- A. Pinards maneuver
- B. Prague maneuver (Correct Answer)
- C. Lovsets maneuver
- D. Burn Marshall method
Explanation: ***Prague maneuver*** - The **Prague maneuver** is used to deliver the aftercoming fetal head in breech delivery when specific traction on the shoulders is needed. - **Prague I (or Prague-Veit)**: Used when the fetal **back is anterior** - the operator's fingers hook over the shoulders while traction is applied. - **Prague II**: Used when the fetal **back is posterior** - less commonly performed. - This maneuver involves supporting the fetal body while applying traction to the shoulders to facilitate head delivery. *Pinard's maneuver* - **Pinard's maneuver** is used to assist with the delivery of the fetal **legs** in a **frank or complete breech** presentation, not the head. - This maneuver involves flexing the hip and knee to bring down a foot, aiding in the delivery of the lower extremities. *Lovset's maneuver* - **Lovset's maneuver** is used during a breech delivery to assist with the delivery of the **shoulders by rotating the fetal trunk**. - It involves rotating the baby's trunk 180 degrees to bring the posterior shoulder anterior under the pubic symphysis, allowing for easier delivery of both arms and shoulders. *Burns-Marshall method* - The **Burns-Marshall method** is another technique used to deliver the aftercoming head in breech delivery. - It involves allowing the fetal body to hang by its own weight until the **nape of the neck and hairline appear** at the vulva, then lifting the body in an arc towards the mother's abdomen to deliver the head by flexion. - While this is also used for head delivery, the **Prague maneuver** involves more direct manual traction and is the answer expected for this examination context.
Question 27: What is the purpose of the Prague maneuver in obstetrics?
- A. To assess the fetal position in deep transverse arrest
- B. To extract extended arms during delivery
- C. To deliver the head in breech presentation when the fetal back is posterior (Correct Answer)
- D. To turn a fetus from breech to head-down position before labor
Explanation: ***To deliver the head in breech presentation when the fetal back is posterior*** - The **Prague maneuver** is a technique specifically designed for the extraction of the fetal head during a **breech delivery**, typically when the fetal back is in the **posterior position**. - It involves placing two fingers of one hand on the maxilla while grasping the shoulders of the fetus from behind with the other hand, allowing traction to flex and deliver the aftercoming head. - This maneuver is particularly useful when the **fetal back is posterior**, making access to the face more difficult; when the back is **anterior**, the Mauriceau-Smellie-Veit maneuver is typically preferred. *To assess the fetal position in deep transverse arrest* - **Deep transverse arrest** refers to a situation where the fetal head is arrested in the transverse diameter of the maternal pelvis; assessment primarily involves vaginal examination and ultrasound. - The Prague maneuver is a **delivery technique**, not a diagnostic assessment tool for fetal position. *To turn a fetus from breech to head-down position before labor* - Turning a fetus from a **breech to a cephalic position** before labor is typically achieved through **external cephalic version (ECV)**. - The Prague maneuver is an **intrapartum intervention** used during the actual delivery of a breech baby, not an antepartum repositioning technique. *To extract extended arms during delivery* - The extraction of **extended arms** during a breech delivery is usually managed by maneuvers such as the **Løvset maneuver** or attempting to sweep the arms down over the chest. - While arm position can affect delivery, the Prague maneuver is primarily focused on the **delivery of the aftercoming head** when the fetal back is posterior.
Question 28: Commonest variety of compound presentation is?
- A. Head with hand (Correct Answer)
- B. Head with both feet
- C. Head, hand & feet
- D. Head with feet
Explanation: ***Head with hand*** - This is the **most frequent type** of compound presentation, where a fetal extremity (typically a hand) prolapses alongside the fetal head into the maternal pelvis. - It occurs due to factors that prevent the fetal head from snugly filling the pelvis, such as **cephalopelvic disproportion** or a **high fetal station**. *Head with foot* - While possible, the presentation of the **head with a foot** is less common than with a hand. - A foot alongside the head often suggests a more complex presentation or potential issues with fetal lie or attitude. *Head with both foot* - The simultaneous presentation of the **head with both feet** is exceedingly rare. - This scenario would indicate a profound degree of space for fetal extremities to descend alongside the head, possibly in cases of extreme prematurity or pelvic relaxation. *Head, hand & foot* - The combined presentation of the **head, a hand, and a foot** is extremely uncommon. - Such a complex presentation would suggest significant fetal mobility in a large pelvic space, making it a very rare occurrence in clinical practice.
Question 29: What is the expected rate of turnover of amniotic fluid in a pregnant woman?
- A. 500 cc/h (Correct Answer)
- B. 1 L/h
- C. 1500 cc/h
- D. 2L/h
Explanation: ***500 cc/h*** - The **amniotic fluid** undergoes a rapid and continuous turnover, with approximately **500 cc/h** being exchanged through multiple pathways. - This dynamic process ensures the constant renewal of the fluid, maintaining its critical functions for fetal development and protection. *1L/hr* - A turnover rate of 1 liter per hour is **higher than the physiological range** for normal amniotic fluid dynamics. - Such a high rate would imply an **abnormal fluid exchange**, potentially leading to imbalances. *1500 cc/h* - This rate represents an **extremely high turnover**, significantly exceeding the typical physiological exchange. - Sustained rates this high are **not consistent with normal amniotic fluid physiology** and could indicate underlying pathology. *2L/h* - A turnover rate of 2 liters per hour is **dangerously high** and far beyond the normal capacity for amniotic fluid exchange. - Such a rapid turnover would be **detrimental to fetal well-being** and is not observed in healthy pregnancies.
Question 30: 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.