Obstetrics and Gynecology
9 questionsWhich of the following statements about nabothian cysts is true?
What is the most common cause of pelvic inflammatory disease?
Which of the following is the PRIMARY risk factor for cervical carcinoma?
What is the most common cause of death in cervical cancer?
Which of the following is not a standard treatment option for CIN III?
What size of Hegar's dilator, when passed through the internal os, indicates cervical incompetence?
Funneling in cervicogram is seen in -
Contracted pelvis is defined as a condition where the dimensions of the pelvis are reduced, making childbirth difficult. What is the minimum shortening of one or more planes that is considered significant?
What is the most common type of conjoint twin?
NEET-PG 2015 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1041: Which of the following statements about nabothian cysts is true?
- A. It is a premalignant condition that requires excision.
- B. It is a malignant condition.
- C. Squamous epithelium grows over columnar epithelium, blocking mucus-secreting glands. (Correct Answer)
- D. It may be associated with chronic irritation and inflammation but is not defined by it.
Explanation: ***Squamous epithelium grows over columnar epithelium, blocking mucus-secreting glands.*** - **Nabothian cysts** form when the **squamous epithelium** of the ectocervix grows over the **columnar epithelium** of the endocervix during the process of **squamous metaplasia**. - This epithelial overgrowth obstructs the ducts of the **mucus-secreting endocervical glands**, leading to mucus retention and cyst formation. - This is the **classic pathophysiological mechanism** and the defining feature of nabothian cyst formation. *It is a premalignant condition that requires excision.* - **Nabothian cysts are completely benign** and have **no malignant or premalignant potential**. - They are **incidental findings** that require **no treatment** and can be safely observed. - Misclassifying them as premalignant would lead to unnecessary surgical interventions. *It is a malignant condition.* - **Nabothian cysts** are universally considered **benign retention cysts** with no malignant characteristics. - They are among the most common benign findings on cervical examination. *It may be associated with chronic irritation and inflammation but is not defined by it.* - While **chronic cervicitis** can be a predisposing factor for squamous metaplasia (which leads to nabothian cysts), this statement is **too vague** to be the best answer. - The **defining characteristic** of a nabothian cyst is the **anatomical mechanism** (squamous epithelium blocking glandular ducts), not the associated inflammatory conditions.
Question 1042: What is the most common cause of pelvic inflammatory disease?
- A. Chlamydia and gonorrhea infections (Correct Answer)
- B. Pelvic peritonitis
- C. Puerperal sepsis
- D. Intrauterine Contraceptive Device (IUCD)
Explanation: ***Correct: Chlamydia and gonorrhea infections*** - **Chlamydia trachomatis** and **Neisseria gonorrhoeae** are the most frequently identified bacterial causes of PID, accounting for the majority of cases. - These infections often begin as **asymptomatic cervical infections** that ascend to the upper genital tract (uterus, fallopian tubes, ovaries). - They cause inflammation and scarring of the fallopian tubes and surrounding pelvic structures, forming the pathological basis of PID. - Early detection and treatment are crucial to prevent long-term complications like infertility and chronic pelvic pain. *Incorrect: Pelvic peritonitis* - **Pelvic peritonitis** is an inflammation of the peritoneum within the pelvis, which is a **complication** of severe PID, not the primary cause. - It represents a more advanced stage of infection where inflammation has spread beyond the reproductive organs to the peritoneal cavity. - While it involves pelvic inflammation, its origin typically stems from untreated bacterial infections like Chlamydia or gonorrhea. *Incorrect: Puerperal sepsis* - **Puerperal sepsis** is an infection of the genital tract occurring specifically after **childbirth, miscarriage, or abortion**. - While it involves pelvic infection, it is a distinct clinical entity related to the **postpartum or post-abortion period**. - PID, in contrast, typically occurs in sexually active women of reproductive age, unrelated to pregnancy outcomes. *Incorrect: Intrauterine Contraceptive Device (IUCD)* - An **IUCD** is an **independent risk factor** for PID, particularly in the first 3 weeks after insertion. - The IUCD itself does not directly cause PID; rather, it may facilitate the entry and ascent of pre-existing cervical infections. - The increased risk is primarily during insertion when bacteria can be introduced into the uterine cavity. - Modern IUCDs have lower PID risk, and the benefit-risk ratio favors their use in appropriate candidates.
Question 1043: Which of the following is the PRIMARY risk factor for cervical carcinoma?
- A. Human papilloma virus (Correct Answer)
- B. Smoking
- C. Low socioeconomic status
- D. All of the options
Explanation: ***Human papilloma virus*** - **High-risk HPV types**, particularly **HPV 16 and 18**, are the primary causative agent of cervical carcinoma, responsible for over 90% of cases. - HPV infection is the **most significant and essential risk factor**, leading to persistent changes in cervical cells that can progress to **dysplasia** and eventually **invasive cancer**. - Cervical cancer is considered an **HPV-associated malignancy**, making HPV the central etiological factor. *Smoking* - **Smoking** is an important cofactor that increases the risk of cervical carcinoma in women with HPV infection, but it is not the primary cause. - Smoking impairs the immune system's ability to clear HPV infections and promotes progression of HPV-induced lesions. - Without HPV infection, smoking alone does not cause cervical cancer. *Low socioeconomic status* - **Low socioeconomic status** is an indirect risk factor associated with reduced access to healthcare and **cervical cancer screening** (Pap smears). - It does not directly cause cervical cancer but leads to delayed diagnosis and treatment, resulting in poorer outcomes. *All of the options* - While all listed factors influence cervical carcinoma risk, **Human papillomavirus (HPV)** is the primary and essential causative agent. - The other factors are cofactors or indirect associations, not primary causes.
Question 1044: What is the most common cause of death in cervical cancer?
- A. Infection
- B. Haemorrhage
- C. Metastasis to vital organs
- D. Renal failure (Correct Answer)
Explanation: ***Renal failure*** - As cervical cancer progresses, it can invade surrounding structures, including the **ureters**. - **Ureteral obstruction** leads to **hydronephrosis** and ultimately **renal failure**, which is a common cause of death. *Infection* - While infections can occur due to immunosuppression or compromised tissue integrity in advanced cancer, they are generally **not the most common direct cause of death**. - Infections are often secondary complications rather than the primary mode of mortality. *Haemorrhage* - Local invasion of blood vessels by advanced cervical cancer can cause **significant bleeding** (haemorrhage). - While potentially life-threatening, it is **less frequent** as a direct cause of death compared to renal failure. *Metastasis to vital organs* - Cervical cancer can metastasize to distant organs like the lungs, liver, or bone; however, direct organ failure solely due to metastases is **less common than renal complications** from local tumor spread. - The impact of metastases often contributes to overall decline but is not the most frequent immediate cause of death.
Question 1045: Which of the following is not a standard treatment option for CIN III?
- A. LLETZ
- B. Conization
- C. Hysterectomy
- D. Wertheim's hysterectomy (Correct Answer)
Explanation: ***Wertheim's hysterectomy*** - A **Wertheim's hysterectomy**, also known as a **radical hysterectomy**, involves removal of the uterus, cervix, parametrium, and upper vagina, along with pelvic lymph node dissection. This is typically reserved for **invasive cervical cancer**, not CIN III. - While hysterectomy can be a treatment option for CIN III in specific circumstances (e.g., patient preference, coexisting uterine pathology), a Wertheim's hysterectomy is an **overly aggressive procedure** for precancerous lesions due to its significant morbidity. *LLETZ* - **Large Loop Excision of the Transformation Zone (LLETZ)**, also known as LEEP (Loop Electrosurgical Excision Procedure), is a common and effective outpatient treatment for CIN III. - It involves using a heated wire loop to **excise the abnormal tissue** from the cervix, allowing for histological examination. *Conization* - **Cold knife conization** involves excising a cone-shaped piece of tissue from the cervix using a scalpel. This method is highly effective for CIN III. - It provides **excellent pathological specimens** for evaluation of margins, which is crucial for confirming complete removal of the lesion. *Hysterectomy* - **Hysterectomy** (removal of the uterus, usually simple hysterectomy) can be considered a treatment option for CIN III, particularly in women who have completed childbearing and have other indications for hysterectomy, or when repeated excisional procedures have failed. - While effective, it is a more **invasive procedure** than LLETZ or conization and generally reserved for specific cases where conservative management is not suitable or desired.
Question 1046: What size of Hegar's dilator, when passed through the internal os, indicates cervical incompetence?
- A. 4
- B. 6
- C. 10
- D. 8 or more (Correct Answer)
Explanation: ***8 or more*** - The passage of a **Hegar's dilator of size 8 mm or larger** through the internal os without resistance is a classic diagnostic criterion for **cervical incompetence** or insufficiency. - This finding suggests a **weakened cervix** that is unable to withstand the pressure of a growing pregnancy, leading to recurrent mid-trimester pregnancy losses or preterm births. *4* - A Hegar's dilator of size 4 mm is relatively small and can often pass through a normal, non-pregnant **cervical os** without indicating pathology. - This size would not be considered abnormal and does not signify **cervical incompetence**. *6* - While a Hegar's dilator of 6 mm is larger than 4 mm, it is still generally within the range that might pass through a normal cervix, especially in **multiparous women**, without definitively diagnosing incompetence. - The threshold for diagnosing **cervical incompetence** is typically set higher, at 8 mm or more. *10* - While the passage of a 10 mm Hegar's dilator would certainly indicate **cervical incompetence**, the diagnostic cutoff is typically considered to be **8 mm or more**. - Any dilator **equal to or greater than 8 mm** confirms the diagnosis, so 10 mm is not the *only* size indicating incompetence.
Question 1047: Funneling in cervicogram is seen in -
- A. Cervical ectopic
- B. During TVS
- C. During labor
- D. Weak cervical tissue leading to pregnancy complications (Correct Answer)
Explanation: ***Weak cervical tissue leading to pregnancy complications*** - **Funneling** in a cervicogram (or during transvaginal ultrasound) indicates the shortening and dilation of the internal cervical os, forming a funnel shape. - This finding is a key indicator of **cervical insufficiency** or **weak cervical tissue**, which significantly increases the risk of preterm birth and other pregnancy complications due to the inability of the cervix to retain the pregnancy. *During labor* - While the cervix dilates and effaces during labor, the term "funneling" specifically refers to the premature opening of the internal os seen *before* active labor, often indicative of **cervical insufficiency**. - During active labor, the entire cervix generally dilates progressively, rather than forming a distinct funnel shape. *Cervical ectopic* - A **cervical ectopic pregnancy** involves the implantation of a fertilized egg within the cervical canal. - While it affects the cervix, the defining characteristic is the presence of an implanted gestational sac, not specifically cervical funneling. *During TVS* - **Transvaginal ultrasound (TVS)** is the primary method used to assess cervical length and detect funneling. - Funneling itself is a sign of cervical changes, observed *via* TVS, rather than TVS *causing* or *being* the funneling.
Question 1048: Contracted pelvis is defined as a condition where the dimensions of the pelvis are reduced, making childbirth difficult. What is the minimum shortening of one or more planes that is considered significant?
- A. 1.5 cm (Correct Answer)
- B. 0.5 cm
- C. 1.25 cm
- D. 1 cm
Explanation: ***1.5 cm*** - A reduction of **1.5 cm or more** in any of the pelvic planes is widely accepted as **clinically significant** to define a contracted pelvis. - Most standard obstetric textbooks (including Williams Obstetrics and DC Dutta) cite **1.5-2 cm** as the threshold for clinically significant pelvic contraction. - This degree of shortening can impede the normal mechanism of labor and increase the risk of **cephalopelvic disproportion**. *1 cm* - While some older references mention 1 cm, the **generally accepted minimum threshold** in modern obstetric practice is **1.5-2 cm**. - A reduction of only 1 cm may not consistently cause significant obstetric complications and falls within the range of normal variation in many cases. *1.25 cm* - This value is **below the standard threshold** of 1.5-2 cm used to define a contracted pelvis in most authoritative obstetric texts. - While it represents some reduction, it does not meet the minimum accepted criterion for clinical significance. *0.5 cm* - A shortening of **0.5 cm** is **insufficient** to classify a pelvis as contracted. - Minor variations within this range fall within the **normal spectrum** and do not typically cause labor complications.
Question 1049: What is the most common type of conjoint twin?
- A. Thoracopagus (Correct Answer)
- B. Omphalopagus
- C. Craniopagus
- D. Rachipagus
Explanation: ***Thoracopagus*** - This type of conjoint twin, fused at the **thorax** and often sharing a heart and liver, is the **most common** variety, accounting for approximately **40%** of all cases. - The shared organs and complex anatomy often pose significant challenges for separation and survival. *Omphalopagus* - These twins are joined at the **abdomen** and typically share a liver, gastrointestinal tract, or other abdominal organs. - This is the second most common type, representing approximately **30-35%** of conjoint twins. *Craniopagus* - This rare form involves fusion at the **head**, often sharing parts of the skull, dura mater, or even brain tissue. - Due to the intricate neurological connections, craniopagus twins present exceptionally complex medical and ethical challenges, accounting for only **2-6%** of cases. *Rachipagus* - These twins are fused dorsally along the **spine** and typically share portions of the vertebral column and spinal cord. - This is an extremely rare type of conjoint twinning, representing less than **2%** of cases.
Pediatrics
1 questionsThere is overlapping of skull sutures which can be reduced with gentle pressure. What is the grade of moulding?
NEET-PG 2015 - Pediatrics NEET-PG Practice Questions and MCQs
Question 1041: There is overlapping of skull sutures which can be reduced with gentle pressure. What is the grade of moulding?
- A. Grade 1
- B. Grade 2 (Correct Answer)
- C. Grade 3
- D. Grade 4
Explanation: ***Grade 2*** - **Grade 2 moulding** is characterized by overriding of the skull sutures that can be reduced with gentle pressure. This indicates moderate moulding of the fetal head. - This degree of moulding is a common finding during labor and delivery and usually resolves without intervention. *Grade 1* - **Grade 1 moulding** involves the apposition (touching) of the skull bones without actual overlap. - It signifies minimal moulding of the fetal head. *Grade 3* - **Grade 3 moulding** involves significant overlapping of the skull sutures that is fixed and cannot be reduced with gentle pressure. - This indicates severe moulding and may sometimes be associated with increased risk of intracranial complications. *Grade 4* - There is no universally recognized "Grade 4" for fetal head moulding in standard classifications. - Moulding is typically classified up to Grade 3, indicating increasing severity.