NEET-PG 2015

1414 Questions — Page 100 of 142

Obstetrics and Gynecology

9 questions

Q991

What does the term 'crowning' refer to in the context of childbirth?

Q992

Which of the following conditions can lead to a prolonged second stage of labor?

Q993

Lovset manoeuvre is used in delivery of:

Q994

Common misdiagnosis of partial mole is

Q995

When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?

Q996

Which is not a risk factor for gestational hypertension

Q997

Which of the following methods is not used for managing shoulder dystocia?

Q998

What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?

Q999

The best method for inducing mid trimester abortion is :

NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs

Question 991: What does the term 'crowning' refer to in the context of childbirth?

A. Biparietal diameter at the inlet of pelvis
B. Biparietal diameter at the ischial spine
C. Biparietal diameter just outside the vulval outlet
D. Biparietal diameter at the vulval outlet (Correct Answer)

Explanation: ***Biparietal diameter at the vulval outlet*** - **Crowning** specifically refers to the moment when the largest diameter of the baby's head (the **biparietal diameter**) has passed through the pelvic outlet and becomes visible at the vaginal opening without receding between contractions. - This signifies that the head is fully engaged and will no longer slip back, making birth imminent. *Biparietal diameter at the inlet of pelvis* - The **biparietal diameter** at the inlet of the pelvis describes the initial engagement of the fetal head into the pelvis, which is a much earlier stage than crowning. - This stage is referred to as **engagement**, not crowning, and there is no visible head at this point. *Biparietal diameter at the ischial spine* - The **ischial spines** are a landmark often used to assess the fetal head's station in the pelvis (how far down it has descended). - While important for assessing progress, the biparietal diameter reaching the ischial spines indicates a **station 0**, which is still internal and not visible at the vulva, thus not crowning. *Biparietal diameter just outside the vulval outlet* - If the **biparietal diameter** is **just outside** the vulval outlet, it implies the head has already been born or is so far progressed that crowning has already occurred or the head is delivering. - Crowning specifically describes the moment it becomes visible and sustained at the outlet, not outside it.

Question 992: Which of the following conditions can lead to a prolonged second stage of labor?

A. Cephalopelvic disproportion
B. All of the options (Correct Answer)
C. Uterine inertia
D. Maternal exhaustion

Explanation: ***All of the options*** - **Uterine inertia**, **maternal exhaustion**, and **cephalopelvic disproportion** are all well-established causes of a prolonged second stage of labor. - These factors either impede effective uterine contractions, reduce the mother's ability to push, or create a physical barrier to fetal descent, respectively. *Uterine inertia* - Refers to **weak** or **ineffective uterine contractions** that are insufficient to expel the fetus. - This directly prolongs the second stage by failing to provide adequate propulsive force. *Maternal exhaustion* - Occurs when the mother becomes too **tired** to effectively push, often due to a long and difficult labor. - Reduced maternal effort leads to a lack of downward pressure, extending the second stage. *Cephalopelvic disproportion* - Characterized by a mismatch between the **size of the fetal head** and the **maternal pelvis**, preventing the head from descending. - This mechanical obstruction inevitably leads to a prolonged, and often ultimately arrested, second stage of labor.

Question 993: 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 994: 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 995: 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 996: 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 997: 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 998: 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 999: 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.

Pharmacology

1 questions

Q991

What is the progestogen of choice in emergency contraception?