What is the primary clinical advantage of the occipitoanterior position in childbirth?
What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?
The best method for inducing mid trimester abortion is :
Lovset manoeuvre is used in delivery of:
Duration of second stage of labor (propulsive stage) in multipara
Which of the following precancerous conditions, if treated, has the highest likelihood of not leading to cancer?
Which of the following statements about abdominal pregnancy is true?
Which is false about stress urinary incontinence?
Which of the following ovarian tumors is most prone to undergo torsion during pregnancy?
In MRKH syndrome, which of the following structures is typically absent?
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 21: 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 22: What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?
- A. 96 hours
- B. 48 hours
- C. 24-48 hours (Correct Answer)
- D. 72 hours
Explanation: ***24-48 hours*** - The FDA-approved protocol for medical abortion with mifepristone and misoprostol specifies a **24- to 48-hour interval** between the administration of the two drugs. - This timing ensures optimal efficacy as it allows mifepristone to adequately sensitize the uterus to the effects of misoprostol. *48 hours* - While 48 hours falls within the recommended range, specifically stating "48 hours" as the only option is less precise than the **24-48 hour window**. - No specific clinical advantage or disadvantage is generally reported for waiting exactly 48 hours over, for instance, 24 hours. *96 hours* - A 96-hour interval is significantly longer than the **FDA-recommended window** and is not part of the standard, evidence-based protocol. - Delaying misoprostol administration beyond 48 hours may **reduce the effectiveness** of the medical abortion and increase the risk of complications. *72 hours* - A 72-hour interval exceeds the upper limit of the **FDA-recommended window** for optimal efficacy. - While some studies have explored extended intervals, the *standard clinical practice* and FDA guidelines do not endorse 72 hours as the primary recommended interval.
Question 23: The best method for inducing mid trimester abortion is :
- A. Dilation and Curettage (D&C)
- B. Injection of Hypertonic Saline
- C. Ethacrydine Lactate
- D. Prostaglandins (Correct Answer)
Explanation: ***Prostaglandins*** - **Prostaglandins** (e.g., dinoprostone, misoprostol) are highly effective in inducing uterine contractions and cervical ripening, making them the preferred method for **mid-trimester abortion**. - They can be administered through various routes (vaginal, oral, buccal) and offer a good balance of efficacy and safety for this gestational age. - Prostaglandins are considered the **current gold standard** for second-trimester medical termination of pregnancy. *Injection of Hypertonic Saline* - Historically used, but **intra-amniotic hypertonic saline** carries significant risks, including hypernatremia, disseminated intravascular coagulation (DIC), and uterine rupture. - It has largely been replaced by safer and more effective methods like prostaglandins due to its adverse event profile. - This method is now considered obsolete in most clinical settings. *Ethacrydine Lactate* - **Ethacrydine lactate** (ethacridine lactate/Rivanol) is an antiseptic agent that was historically used for mid-trimester abortion via intra-amniotic injection. - While it was effective in inducing abortion, it has been largely abandoned due to complications, prolonged induction time, and the availability of safer alternatives. - It is **not the preferred method** compared to prostaglandins, which have better safety profiles and efficacy. *Dilation and Curettage (D&C)* - **Dilation and curettage (D&C)** is primarily used for first-trimester abortions or for managing incomplete abortions and miscarriages. - In the mid-trimester, the uterus is larger and the fetal tissue is more substantial, making D&C less safe and often requiring extensive dilation or potentially leading to complications like uterine perforation or hemorrhage. - **Dilation and evacuation (D&E)** may be used in mid-trimester but requires specialized training and equipment.
Question 24: 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 25: Duration of second stage of labor (propulsive stage) in multipara
- A. Approximately 20 minutes (Correct Answer)
- B. 40 minutes
- C. 1 hour
- D. 10 minutes
Explanation: ***Approximately 20 minutes*** - In **multiparas**, the second stage of labor, also known as the **propulsive stage**, is typically shorter due to prior experience with childbirth. - While there is variability, an average duration of **20 minutes** for this stage is commonly observed in multiparous women. *40 minutes* - A duration of 40 minutes for the propulsive stage would be considered on the longer side for a **multipara**, often approaching the upper limits of normal. - While not necessarily abnormal, it is longer than the **average expected time** for multiparous women. *1 hour* - A second stage duration of **1 hour** in a multipara would generally be considered prolonged and might warrant intervention or closer monitoring. - This duration is more consistent with the **upper limit of normal** in nulliparous women or cases of arrest of labor in multiparas. *10 minutes* - While some multiparous women may have a very rapid second stage, **10 minutes** is on the shorter end of the average. - This could indicate a **precipitous labor**, which can carry its own risks such as maternal lacerations and neonatal complications.
Question 26: 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 27: Which of the following statements about abdominal pregnancy is true?
- A. Primary abdominal pregnancy is a common condition.
- B. Most fetuses in abdominal pregnancies survive to term.
- C. Leaving the placenta behind can lead to infection. (Correct Answer)
- D. Separation of the placenta is always necessary.
Explanation: ***f6629bc8-61b2-4393-bb4c-9c32cd943e34*** - **Placenta acreta-like implantation** of the placenta into intra-abdominal organs or the abdominal wall makes removal dangerous due to potential damage and massive hemorrhage. - While leaving it in place can lead to serious complications like **infection**, **abscess formation**, or **secondary hemorrhage** as it degenerates, the risks of immediate removal often outweigh these, necessitating careful observation and management. *020c0067-d7b2-4fc2-85ae-2d6ba40ab437* - **Primary abdominal pregnancy** is extremely rare, accounting for less than 1% of all extrauterine pregnancies. - Abdominal pregnancies are generally **secondary** due to tubal abortion or rupture with subsequent reimplantation. *3560b92d-a63d-4966-8872-e4f56a82882f* - **Fetal survival rates** in abdominal pregnancies are very low, with a high incidence of **fetal anomalies** and **perinatal mortality**. - The abnormal placental implantation and lack of amniotic fluid protection lead to significant **growth restriction** and compression deformities. *5ab987e0-68ca-43f2-a8f2-238a5eb0c4f8* - The decision to remove the **placenta** in an abdominal pregnancy is complex and depends on its implantation site; often, it is left in situ due to the high risk of **hemorrhage** from attempting removal. - Removing the placenta can cause **uncontrollable bleeding**, especially if it is attached to vital organs or large blood vessels.
Question 28: Which is false about stress urinary incontinence?
- A. More common in men (Correct Answer)
- B. It is due to weakening of pelvic floor muscles
- C. Prostate surgery may be a cause
- D. It occurs during increased abdominal pressure
Explanation: ***More common in men*** - **Stress urinary incontinence (SUI)** is significantly more prevalent in **women** due to anatomical differences and factors like childbirth. - While it can occur in men, especially after prostate surgery, the overall incidence is higher in females. *It is due to weakening of pelvic floor muscles* - Weakening of the **pelvic floor muscles** is a primary cause of SUI, leading to insufficient support for the urethra and bladder neck. - This weakness compromises the ability to maintain urethral closure pressure during activity. *Prostate surgery may be a cause* - **Radical prostatectomy** for prostate cancer is a common cause of SUI in men, as it can damage the urethral sphincter. - Damage to the internal or external urethral sphincter during surgery impairs the ability to control urine flow. *It occurs during increased abdominal pressure* - SUI characteristically involves involuntary urine leakage during activities that increase **intra-abdominal pressure**, such as coughing, sneezing, laughing, or exercising. - This increased pressure overcomes the weakened urethral resistance, leading to urine loss.
Question 29: Which of the following ovarian tumors is most prone to undergo torsion during pregnancy?
- A. Serous cystadenoma
- B. Mucinous cystadenoma
- C. Dermoid cyst (Correct Answer)
- D. Theca lutein cyst
Explanation: ***Dermoid cyst*** - **Dermoid cysts**, or mature cystic teratomas, are the **most common ovarian tumors** to undergo torsion, especially during pregnancy due to their mobility and moderate size. - They are often **unilateral** and benign, containing various mature tissues such as hair, teeth, and sebaceous material. *Serous cystadenoma* - While common, **serous cystadenomas** are generally **less mobile** than dermoid cysts and thus have a lower propensity for torsion. - They are typically filled with **clear, watery fluid** and can grow to be quite large. *Mucinous cystadenoma* - **Mucinous cystadenomas** tend to be **larger** than dermoid cysts and are less prone to torsion due to their size and often fixed position within the pelvis. - They are filled with **thick, gelatinous mucin** and can reach massive sizes, sometimes filling the entire abdominal cavity. *Theca lutein cyst* - **Theca lutein cysts** are usually **bilateral** and occur with conditions like **gestational trophoblastic disease** or **ovarian hyperstimulation**. - While they can be large, their often bilateral nature and underlying pathological conditions make them **less likely to independently twist** as a primary event compared to a freely mobile dermoid cyst.
Question 30: In MRKH syndrome, which of the following structures is typically absent?
- A. Testes
- B. Uterus (Correct Answer)
- C. Breast development
- D. Pubic hair development
Explanation: ***Uterus*** - **Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome** is characterized by congenital aplasia of the **uterus** and upper two-thirds of the vagina. - This is due to abnormal development of the **Müllerian ducts**, which are embryonic structures that form the uterus, fallopian tubes, cervix, and upper vagina. *Breast development* - **Breast development** is typically normal in MRKH syndrome as it is influenced by ovarian hormones, and the **ovaries are usually functional** in these individuals. - Normal breast development indicates that the **estrogen production** from the ovaries is intact. *Pubic hair development* - **Pubic hair development** is also normal in MRKH syndrome, as it is a secondary sexual characteristic driven by **adrenal androgens** and ovarian hormones, which are generally not affected. - The presence of pubic hair indicates **normal adrenal and ovarian androgen production**. *Testes* - **Testes** are male gonads and are therefore not present in individuals with MRKH syndrome, as these patients are **genetically female (46,XX karyotype)**. - The absence of testes is a normal finding in females, and thus not a characteristic feature or absence due to MRKH syndrome itself.