Which of the following conditions is most commonly associated with malodorous vaginal discharge?
What is the primary clinical advantage of the occipitoanterior position in childbirth?
Most common antigen involved in erythroblastosis fetalis is:
Lovset manoeuvre is used in delivery of:
Which is not a risk factor for gestational hypertension
When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?
Common misdiagnosis of partial mole is
Which of the following methods is not used for managing shoulder dystocia?
Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?
In which part of the fallopian tube is ectopic pregnancy most likely to survive longer?
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 11: Which of the following conditions is most commonly associated with malodorous vaginal discharge?
- A. Bacterial vaginosis (Correct Answer)
- B. Chlamydia trachomatis
- C. Trichomonas vaginalis
- D. Neisseria gonorrhoeae
Explanation: ***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.
Question 12: What is the primary clinical advantage of the occipitoanterior position in childbirth?
- A. It is the most favorable position for vaginal delivery.
- B. It allows optimal fetal head flexion reducing the presenting diameter. (Correct Answer)
- C. Anterior fontanelle is anterior in this position.
- D. It is associated with shorter labor duration and fewer complications.
Explanation: ***It allows optimal fetal head flexion reducing the presenting diameter.*** - In the occipitoanterior (OA) position, the fetal head is **well-flexed**, allowing the **smallest diameter** of the fetal head to present to the maternal pelvis - The presenting diameter is the **suboccipitobregmatic diameter** (~9.5 cm), which is the smallest anteroposterior diameter of the fetal head - This optimal flexion is the **primary clinical advantage** as it facilitates easier passage through the birth canal and reduces maternal and fetal trauma - The **occiput (posterior fontanelle)** faces anteriorly in this position, which is a key anatomical landmark used to diagnose OA position during vaginal examination *It is the most favorable position for vaginal delivery.* - While this statement is true, it is **too general** and doesn't explain the specific anatomical or mechanical reason - It describes an outcome rather than explaining the **primary clinical advantage** in terms of fetal head mechanics *Anterior fontanelle is anterior in this position.* - This statement is **anatomically incorrect** - In occipitoanterior position, the **occiput (posterior fontanelle)** is anterior, not the anterior fontanelle - The anterior fontanelle (bregma) is actually positioned **posteriorly** in the OA position *It is associated with shorter labor duration and fewer complications.* - This is a **consequence** of the favorable OA position, not the primary clinical advantage itself - The shorter labor and fewer complications result from the optimal fetal head flexion and smaller presenting diameter - This option describes an **outcome** rather than the underlying anatomical/mechanical advantage
Question 13: Most common antigen involved in erythroblastosis fetalis is:
- A. C antigen in Rh group
- B. E antigen in Rh group
- C. Duffy antigen
- D. D antigen in Rh group (Correct Answer)
Explanation: ***D antigen in Rh group*** - The **D antigen** is the most immunogenic of the Rh antigens and is responsible for the vast majority of cases of **erythroblastosis fetalis** (hemolytic disease of the fetus and newborn). - When an **Rh-negative mother** is exposed to Rh-positive fetal blood (usually during previous pregnancies or transfusions), she can form antibodies against the D antigen, which can then cross the placenta in subsequent pregnancies and attack Rh-positive fetal red blood cells. *C antigen in Rh group* - While the **C antigen** is part of the Rh blood group system, antibodies to it are much less common and typically cause less severe hemolytic disease compared to anti-D antibodies. - The C antigen is less immunogenic than the D antigen, meaning it is less likely to provoke an immune response in an Rh-negative individual. *E antigen in Rh group* - Similar to the C antigen, the **E antigen** is another Rh antigen, but antibodies against it (anti-E) are also less frequently implicated in severe erythroblastosis fetalis than anti-D. - Antibodies to E can cause hemolytic disease, but their clinical significance is usually milder than that of anti-D. *Duffy antigen* - The **Duffy antigen system** is separate from the Rh system and is known for its role in resistance to certain malarial parasites (e.g., *Plasmodium vivax*). - Although antibodies to Duffy antigens (anti-Fya, anti-Fyb) can cause **hemolytic disease of the fetus/newborn**, they are a far less common cause of erythroblastosis fetalis than antibodies to the Rh D antigen.
Question 14: Lovset manoeuvre is used in delivery of:
- A. Arms (Correct Answer)
- B. Head
- C. Breech
- D. Foot
Explanation: ***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.
Question 15: Which is not a risk factor for gestational hypertension
- A. Primigravida
- B. Factor V Leiden mutation
- C. Smoking (Correct Answer)
- D. Low maternal age
Explanation: ***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.
Question 16: When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?
- A. Forceps may be applied if necessary. (Correct Answer)
- B. Crowning occurs at this stage.
- C. There is a risk of deep transverse arrest.
- D. Episiotomy must be performed at this station.
Explanation: ***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.
Question 17: Common misdiagnosis of partial mole is
- A. Choriocarcinoma
- B. Complete mole
- C. Ectopic pregnancy
- D. Threatened abortion (Correct Answer)
Explanation: ***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.
Question 18: Which of the following methods is not used for managing shoulder dystocia?
- A. Zavanelli maneuver
- B. Wood's maneuver
- C. Hegar's maneuver (Correct Answer)
- D. McRobert's maneuver
Explanation: *McRobert's maneuver* - This maneuver is a common first-line intervention for shoulder dystocia, involving sharp **flexion of the mother's hips** back towards her abdomen to flatten the sacrum and rotate the symphysis pubis anteriorly. - It works by increasing the functional diameter of the **pelvic outlet**, potentially dislodging the anterior shoulder. ***Hegar's maneuver*** - **Hegar's sign** is a clinical finding related to early pregnancy, indicating the **softening of the lower uterine segment** (isthmus) upon bimanual examination. - It is a diagnostic sign of pregnancy and **not a method used to resolve shoulder dystocia**. *Zavanelli maneuver* - The **Zavanelli maneuver** is a last-resort intervention for shoulder dystocia, involving the **replacement of the fetal head into the uterus** followed by immediate delivery via **cesarean section**. - This is a highly invasive procedure with significant risks to both mother and fetus, used when other maneuvers have failed. *Wood's maneuver* - **Wood's maneuver** involves **rotating the fetal shoulders** by applying pressure to the posterior aspect of the anterior shoulder or the anterior aspect of the posterior shoulder to achieve a corkscrew effect. - This rotation can help dislodge an impacted shoulder or facilitate its passage under the symphysis pubis.
Question 19: Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?
- A. Cervical intraepithelial Neoplasia (Correct Answer)
- B. Ductal carcinoma in situ of breast
- C. Lobular carcinoma in situ of breast
- D. Vaginal intraepithelial neoplasia
Explanation: ***Cervical intraepithelial neoplasia (CIN)*** - CIN has a high success rate with treatment (e.g., **cryotherapy**, **LEEP**), often completely eradicating the dysplastic cells and preventing progression to **invasive cervical cancer**. - The effectiveness of screening via **Pap smears** allows for early detection and intervention, significantly reducing cancer risk. *Ductal carcinoma in situ (DCIS) of breast* - While treatable, DCIS carries a higher risk of recurrence and progression to **invasive breast cancer** in the same or contralateral breast compared to CIN. - Treatment often involves **lumpectomy** with or without radiation, and sometimes **total mastectomy**, reflecting its more serious potential. *Lobular carcinoma in situ (LCIS) of breast* - LCIS is largely considered a **risk indicator** for future invasive cancer in either breast, rather than a direct precursor that inevitably progresses. - Management often involves **close surveillance** or **chemoprevention**, as surgical excision does not prevent cancer development in other areas of the breast. *Vaginal intraepithelial neoplasia (VAIN)* - While treatable, VAIN is less common and often coexists with or follows **cervical or vulvar neoplasia**, indicating a broader field defect due to **HPV**. - Recurrence rates post-treatment can be significant, and patients often require long-term follow-up due to the continued risk of progression.
Question 20: In which part of the fallopian tube is ectopic pregnancy most likely to survive longer?
- A. Isthmus
- B. Ampulla
- C. Cornua
- D. Interstitial (Correct Answer)
Explanation: ***Interstitial*** - An **interstitial (intramural) pregnancy** occurs in the portion of the fallopian tube that passes through the muscular wall of the uterus, known as the **cornua**. This position allows for a larger and more distensible space, potentially accommodating the pregnancy for a longer duration before rupture. - The surrounding **myometrial tissue** can provide a temporary blood supply and structural support, leading to later presentation (often up to 12-16 weeks) and often more significant hemorrhage upon rupture due to the rich vascularization of the uterine wall. - Interstitial pregnancies account for approximately 2-4% of all ectopic pregnancies but have a higher mortality rate due to massive hemorrhage when rupture occurs. *Isthmus* - The **isthmus** is the narrowest part of the fallopian tube, making it less accommodating for an ectopic pregnancy. - Pregnancies here tend to rupture earlier (typically by 6-8 weeks) due to limited space and thinner muscular walls. - Accounts for approximately 12% of tubal ectopic pregnancies. *Ampulla* - The **ampulla** is the most common site for ectopic pregnancies (approximately 70-80%), but pregnancies here typically rupture earlier than interstitial ones (usually by 8-12 weeks). - While wider than the isthmus, it lacks the substantial myometrial support of the interstitial portion. - The ampullary wall is thin and distensible but cannot sustain pregnancy as long as the interstitial portion. *Cornua* - While the interstitial part of the tube is located within the uterine wall (cornua), \"cornua\" itself refers to the upper angles of the uterus where the fallopian tubes enter. - The term **\"cornual pregnancy\"** is sometimes used interchangeably with **\"interstitial pregnancy,\"** though some authorities distinguish between them based on precise location. - Without the specific context of \"interstitial,\" this option is less precise in identifying the segment of the fallopian tube associated with prolonged survival.