Obstetrics and Gynecology
8 questionsWhich type of suture is primarily used for the repair of a complete perineal tear?
Which type of fistula can present with both normal urinary voiding and continuous urine leakage simultaneously?
What percentage of women typically deliver on their Estimated Due Date (EDD)?
In which obstetric condition is assisted head delivery typically performed?
At what point does the uterus return to being classified as a pelvic organ after pregnancy?
What is the expected rate of turnover of amniotic fluid in a pregnant woman?
What is the recommended management for jaundice due to obstetric cholestasis in the third trimester?
What is the purpose of the Prague maneuver in obstetrics?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1261: Which type of suture is primarily used for the repair of a complete perineal tear?
- A. Monocryl
- B. Catgut
- C. Silk
- D. Vicryl (Correct Answer)
Explanation: ***Correct Answer: Vicryl (Polyglactin 910)*** - **Vicryl is the gold standard suture material** for repair of complete perineal tears (third and fourth-degree) - It is a **synthetic absorbable braided suture** with excellent tensile strength that maintains tissue support during critical healing phase - **Absorption profile**: Loses 50% tensile strength by 2 weeks, completely absorbed in 56-70 days, ideal for perineal tissue healing - **Minimal tissue reaction** and low infection risk compared to natural sutures - **Recommended by RCOG and ACOG guidelines** for layer-by-layer repair of perineal tears involving anal sphincter *Incorrect: Monocryl* - Monocryl (Poliglecaprone 25) is a fast-absorbing monofilament suture primarily used for **subcuticular skin closure** - Not the first choice for deep tissue repair of complete perineal tears - Has faster absorption (90-120 days) which may not provide adequate support for sphincter repair *Incorrect: Catgut* - Catgut is a natural absorbable suture that was **historically used but is now largely obsolete** - **Higher tissue reaction**, increased infection risk, and unpredictable absorption make it unsuitable - Modern synthetic sutures like Vicryl have replaced catgut in current obstetric practice *Incorrect: Silk* - Silk is a **non-absorbable suture** that is inappropriate for perineal repair - Would require removal and carries risk of chronic foreign body reaction - Never used for internal structures in perineal reconstruction
Question 1262: Which type of fistula can present with both normal urinary voiding and continuous urine leakage simultaneously?
- A. Vesicovaginal Fistula
- B. Ureterovaginal Fistula (Correct Answer)
- C. Uretrovaginal Fistula
- D. Vesicoperitoneal Fistula
Explanation: ***Ureterovaginal Fistula*** - With a **ureterovaginal fistula**, urine can still flow from the bladder through the urethra, allowing for **normal voiding**. - Simultaneously, urine directly bypasses the bladder from the ureter into the vagina, causing **continuous leakage** independent of bladder function. *Vesicovaginal Fistula* - A **vesicovaginal fistula** typically leads to continuous urine leakage through the vagina because the bladder contents directly escape. - This often results in **no normal voiding** or significantly reduced voiding as urine does not accumulate in the bladder. *Uretrovaginal Fistula* - A **urethrovaginal fistula** connects the urethra directly to the vagina. - This usually results in **urine leakage during voiding** or when pressure is exerted, rather than continuous leakage with normal bladder emptying. *Vesicoperitoneal Fistula* - A **vesicoperitoneal fistula** involves leakage of urine from the bladder into the peritoneal cavity. - This condition presents with **ascites** and abdominal signs, not vaginal leakage or normal voiding combined with continuous leakage.
Question 1263: 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 1264: In which obstetric condition is assisted head delivery typically performed?
- A. Shoulder dystocia
- B. Breech presentation (Correct Answer)
- C. Transverse lie
- D. Normal delivery
Explanation: ***Breech presentation*** - In a **breech presentation**, the baby's buttocks or feet are delivered first, necessitating assisted head delivery to prevent **head entrapment** in the maternal pelvis, which can lead to fetal hypoxia or trauma. - Techniques like the **Mauriceau-Smellie-Veit maneuver** are employed to carefully deliver the fetal head after the body. *Shoulder dystocia* - This condition involves the impaction of the fetal shoulder against the maternal symphysis pubis after the head has been delivered. - The focus of management is on delivering the shoulders, not the head, through maneuvers such as the **McRoberts maneuver** or **suprapubic pressure**. *Transverse lie* - A **transverse lie** means the baby is positioned horizontally across the uterus, preventing vaginal delivery without intervention (e.g., external cephalic version or C-section). - This position requires repositioning or surgical delivery of the entire fetus, and assisted head delivery is not the primary concern. *Normal delivery* - In a **normal (vertex) delivery**, the fetal head presents first and typically delivers spontaneously with minimal assistance. - The head usually flexes and rotates to navigate the birth canal on its own, so specific assisted head delivery techniques are not typically required.
Question 1265: At what point does the uterus return to being classified as a pelvic organ after pregnancy?
- A. 2 weeks
- B. 4 weeks
- C. 12 weeks
- D. 6 weeks (Correct Answer)
Explanation: ***6 weeks*** - By **6 weeks postpartum**, the uterus typically has undergone significant involution, returning to its **pre-pregnancy size and weight**. - At this point, it is no longer palpable abdominally and descends back into the **pelvic cavity**, classifying it again as a pelvic organ. *4 weeks* - While significant involution occurs by 4 weeks, the uterus is generally still slightly enlarged and might be palpable just above the **symphysis pubis**. - It has not fully returned to its non-pregnant size or its definitive location as a purely pelvic organ at this stage. *12 weeks* - By 12 weeks postpartum, the uterus has long since returned to its pre-pregnancy size and relocated to the **pelvic cavity**; this period is past the typical time for reclassification. - Involution is generally complete earlier than 12 weeks. *2 weeks* - At 2 weeks postpartum, the uterus is still undergoing rapid **involution** but is significantly larger than its pre-pregnancy size. - It remains palpable abdominally, usually midway between the **umbilicus** and the pubic symphysis, and has not yet descended back into the pelvic cavity.
Question 1266: 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 1267: What is the recommended management for jaundice due to obstetric cholestasis in the third trimester?
- A. Induction of labour at 37 weeks
- B. Induction of labour at 42 weeks
- C. Induction of labour at 38 weeks (Correct Answer)
- D. Wait for spontaneous labour
Explanation: ***Induction of labour at 38 weeks*** - **Obstetric cholestasis (Intrahepatic Cholestasis of Pregnancy)** is associated with increased risk of **stillbirth**, particularly beyond 37-38 weeks gestation. - Induction at **37-38 weeks** is recommended to balance reducing stillbirth risk while minimizing prematurity complications. - **Current practice**: Timing depends on **bile acid levels** - delivery at 37-38 weeks for bile acids >40 μmol/L, or 38-39 weeks for milder cases (19-39 μmol/L). - This option represents the standard management approach for most cases of obstetric cholestasis. *Induction of labour at 37 weeks* - Delivery at 37 weeks is also acceptable and increasingly preferred, particularly for **severe disease** (bile acids >40 μmol/L) or when there are additional risk factors. - Both 37 and 38 weeks are within the recommended window; the choice depends on **disease severity** and individual risk assessment. - This is not incorrect, but 38 weeks represents a slightly more conservative approach balancing risks. *Induction of labour at 42 weeks* - Waiting until 42 weeks significantly increases the risk of **intrauterine fetal death (IUFD)** in pregnancies complicated by obstetric cholestasis. - Prolonged exposure to **elevated bile acids** is toxic to the fetus and increases stillbirth risk, especially after 37-38 weeks. - This approach is **contraindicated** in obstetric cholestasis. *Wait for spontaneous labour* - Expectant management beyond 38 weeks is considered **unsafe** due to the unpredictable and progressive risk of **sudden intrauterine death**. - Active management with planned delivery at 37-38 weeks is the standard of care to prevent stillbirth. - Waiting for spontaneous labor exposes the fetus to unacceptable risks.
Question 1268: 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.
Pharmacology
2 questionsThe mechanism by which ergometrine stops postpartum hemorrhage is that it:
In ophthalmology, if a patient is allergic to aminoesters, which local anesthetic can be safely used?
NEET-PG 2013 - Pharmacology NEET-PG Practice Questions and MCQs
Question 1261: The mechanism by which ergometrine stops postpartum hemorrhage is that it:
- A. Induces platelet aggregation
- B. Promotes coagulation
- C. Causes vasoconstriction of uterine arteries
- D. Increases tone of uterine muscle (Correct Answer)
Explanation: ***Increases tone of uterine muscle*** - **Ergometrine** is an **ergot alkaloid** that directly stimulates **uterine smooth muscle contractions**. - These sustained contractions lead to **compression of blood vessels within the myometrium**, thereby reducing blood flow and controlling **postpartum hemorrhage**. *Causes vasoconstriction of uterine arteries* - While ergometrine does have some generalized **vasoconstrictive effects**, its primary mechanism of action in controlling postpartum hemorrhage is not mainly through direct vasoconstriction of large uterine arteries. - The crucial effect is the **sustained uterine contraction** which mechanically occludes blood vessels, rather than chemical constriction of the vessels themselves. *Induces platelet aggregation* - Ergometrine does not primarily act by inducing **platelet aggregation**; this is a function of specific clotting factors and platelet activators. - Its therapeutic effect against hemorrhage is mediated through its action on **uterine contractility**, not on the cellular components of coagulation. *Promotes coagulation* - Ergometrine does not directly promote the **coagulation cascade** or enhance the formation of fibrin clots. - Its mechanism of action is distinct from agents that affect intrinsic or extrinsic pathways of coagulation.
Question 1262: In ophthalmology, if a patient is allergic to aminoesters, which local anesthetic can be safely used?
- A. Procaine
- B. Cocaine
- C. Prilocaine (Correct Answer)
- D. Tetracaine
Explanation: **Local anesthetics are classified into two chemical groups: esters (aminoesters) and amides. Allergies to esters typically do not cross-react with amides.** ***Prilocaine*** - **Prilocaine** is an **amide-type local anesthetic**, and allergies to **aminoesters** typically do not cross-react with **amides**. - It is a safe alternative in patients with a known allergy to **ester-type local anesthetics**. *Cocaine* - **Cocaine** is an **ester-type local anesthetic**, sharing a similar chemical structure with **aminoesters**. - Patients allergic to **aminoesters** are likely to experience a **cross-reaction** with **cocaine**. *Procaine* - **Procaine** is a classic **ester-type local anesthetic** (an aminoester). - An allergy to aminoesters directly implies an allergy to **procaine** due to its chemical classification. *Tetracaine* - **Tetracaine** is also an **ester-type local anesthetic** (an aminoester). - It is contraindicated in patients with an allergy to **aminoesters** due to the high risk of **allergic reaction**.