NEET-PG 2018 — Obstetrics and Gynecology

Q: What is the first-line maneuver for management of shoulder dystocia?

Sharp flexion of hip joints towards abdomen. ***Sharp flexion of hip joints towards abdomen*** - This maneuver, known as the **McRoberts maneuver**, widens the anterior-posterior diameter of the **pelvis** and flattens the sacrum. - It increases the likelihood of dislodging the impacted fetal shoulder from behind the symphysis pubis. *Supra pubic pressure* - **Suprapubic pressure** is applied to the fetal anterior shoulder to dislodge it from the symphysis pubis and guide it under the maternal pubic bone. - This maneuver is typically performed *in conjunction with* the McRoberts maneuver, but the question specifies "sharp flexion of hip joints towards abdomen," which is McRoberts alone. *90 degree rotation of posterior shoulder* - This describes the **Woods screw maneuver**, which involves rotating the posterior shoulder to facilitate delivery. It is a secondary maneuver used if McRoberts and suprapubic pressure are insufficient. - The question asks for the primary management step, and the McRoberts maneuver (sharp flexion) is usually the first line of intervention. *Emergency c-section* - An **emergency C-section** is generally not indicated for the acute management of shoulder dystocia once the head has delivered, as it is a **delivery complication** happening during vaginal birth. - Management focuses on specific maneuvers to release the impacted shoulders through the vagina. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What type of uterine anomaly is shown in this X-ray HSG image?

Unicornuate uterus. ***Unicornuate uterus*** - The image shows a single, elongated uterine horn with a single fallopian tube arising from it, consistent with a **unicornuate uterus**. - This congenital anomaly results from the **failure of one Müllerian duct to develop**, leading to an abnormally shaped uterus. *Septate uterus* - A **septate uterus** would show a normal uterine fundus with an internal septum dividing the uterine cavity. - This image clearly depicts only **one rudimentary horn** and no visible septum. *Uterus didelphys* - **Uterus didelphys** involves two completely separate uteri, each with its own cervix and vagina. - The image does not show evidence of a **second, separate uterine structure**. *Bicornuate uterus* - A **bicornuate uterus** is characterized by two distinct uterine horns, which fuse at the cervix or lower uterine segment, creating a heart-shaped appearance of the fundus. - The image shows a **single, long horn** rather than two distinct horns. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Extramammary Paget's disease of the vulva is most commonly associated with which other cancer?

Vulvar cancer. ***Vulvar cancer*** - **Extramammary Paget's disease (EMPD)** frequently presents in the vulvar region and is associated with an underlying **adenocarcinoma** in up to 30% of cases. - The disease involves intraepithelial adenocarcinoma cells that can spread locally and, in some instances, indicates a synchronous or metachronous **internal malignancy**, often of genitourinary or gastrointestinal origin, but primarily vulvar adenocarcinoma in this context. *Vaginal cancer* - While Paget's disease can occur in other anogenital areas, its association with **primary vaginal cancer** is much less common compared to vulvar involvement. - **Vaginal Paget's disease** is rare and usually represents secondary spread from a vulvar primary or an underlying bladder/urethral carcinoma. *Cervical cancer* - **Paget's disease** is not typically associated with **cervical cancer**. Cervical cancers are predominantly squamous cell carcinomas or adenocarcinomas arising from the transformation zone. - While cervical adenocarcinoma can present with similar cells to Paget's, it is a distinct entity and not a common association. *Uterine cancer* - **Uterine cancer**, primarily endometrial carcinoma, has no direct or common association with **Paget's disease**. - Paget's disease primarily affects the skin and can be associated with underlying gland cancers, but these are generally in proximity to the epidermal involvement rather than distant uterine sites. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What are the effects of Progesterone-only pills?

All of the options may occur. ***All of the options may occur*** - Progesterone-only pills (POPs) work through **multiple complementary mechanisms** that collectively provide effective contraception. - All three effects occur simultaneously and contribute to the overall contraceptive efficacy of POPs. - Understanding these mechanisms helps explain why POPs are effective despite lower hormone doses compared to combined oral contraceptives. **Mechanism 1: May suppress ovulation** - POPs can **partially suppress ovulation**, preventing the release of an egg. - Traditional POPs suppress ovulation in approximately 40-60% of cycles, while newer desogestrel-containing POPs achieve higher rates (97-99%). - This effect depends on the dose and type of progestin used in the formulation. **Mechanism 2: Thins the lining of the uterus** - Progesterone causes **endometrial atrophy**, making the uterine lining thin and unsuitable for embryo implantation. - This hostile uterine environment acts as a backup contraceptive mechanism if ovulation and fertilization occur. - Endometrial changes occur consistently with POP use. **Mechanism 3: Thickens cervical mucus** - This is the **primary and most consistent mechanism** of POPs. - Progesterone significantly **increases cervical mucus viscosity** and reduces its quantity within hours of administration. - The thickened mucus creates a physical barrier that prevents sperm penetration, motility, and viability. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which of the following is not a high-risk pregnancy?

Age 25-30 years. ***Age 25-30 years*** - An age of **25-30 years** is generally considered the optimal reproductive age range, and pregnancies within this bracket are typically classified as low-risk based on age alone. - This age range carries the lowest statistical risk for both maternal and fetal complications, assuming no other co-morbidities. *Previous history of manual removal of placenta* - A previous history of manual removal of the placenta indicates a risk factor for **recurrent placental retention** or **morbidly adherent placenta** in future pregnancies, making it a high-risk factor. - This history suggests an increased likelihood of complications such as **postpartum hemorrhage** and can influence the management of subsequent deliveries. *Anemia* - **Anemia** in pregnancy, especially severe iron deficiency anemia, is considered a high-risk factor due to increased maternal and fetal morbidity. - It can lead to complications such as **preterm delivery**, **low birth weight**, and difficulties tolerating blood loss during delivery. *Diabetes mellitus* - **Diabetes mellitus**, whether pre-existing or gestational, makes a pregnancy high-risk due to potential adverse effects on both the mother and the fetus. - Risks include **preeclampsia**, **macrosomia**, **neonatal hypoglycemia**, and **congenital anomalies**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

23 Previous Year Questions with Answers & Explanations

Questions

What is the first-line maneuver for management of shoulder dystocia?

What type of uterine anomaly is shown in this X-ray HSG image?

Extramammary Paget's disease of the vulva is most commonly associated with which other cancer?

What are the effects of Progesterone-only pills?

Which of the following is not a high-risk pregnancy?

Which of the following methods is known as a fimbriectomy procedure?

What is meant by Superfecundation?

Best time to perform the quadruple test is:

Long-standing pelvic inflammatory disease (PID) may lead to which of the following complications?

Q10

Dilatation & curettage (D&C) is contraindicated in-

NEET-PG 2018 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs

Question 1: What is the first-line maneuver for management of shoulder dystocia?

A. 90 degree rotation of posterior shoulder
B. Emergency c-section
C. Supra pubic pressure
D. Sharp flexion of hip joints towards abdomen (Correct Answer)

Explanation: ***Sharp flexion of hip joints towards abdomen*** - This maneuver, known as the **McRoberts maneuver**, widens the anterior-posterior diameter of the **pelvis** and flattens the sacrum. - It increases the likelihood of dislodging the impacted fetal shoulder from behind the symphysis pubis. *Supra pubic pressure* - **Suprapubic pressure** is applied to the fetal anterior shoulder to dislodge it from the symphysis pubis and guide it under the maternal pubic bone. - This maneuver is typically performed *in conjunction with* the McRoberts maneuver, but the question specifies "sharp flexion of hip joints towards abdomen," which is McRoberts alone. *90 degree rotation of posterior shoulder* - This describes the **Woods screw maneuver**, which involves rotating the posterior shoulder to facilitate delivery. It is a secondary maneuver used if McRoberts and suprapubic pressure are insufficient. - The question asks for the primary management step, and the McRoberts maneuver (sharp flexion) is usually the first line of intervention. *Emergency c-section* - An **emergency C-section** is generally not indicated for the acute management of shoulder dystocia once the head has delivered, as it is a **delivery complication** happening during vaginal birth. - Management focuses on specific maneuvers to release the impacted shoulders through the vagina.

Question 2: What type of uterine anomaly is shown in this X-ray HSG image?

A. Septate uterus
B. Uterus didelphys
C. Unicornuate uterus (Correct Answer)
D. Bicornuate uterus

Explanation: ***Unicornuate uterus*** - The image shows a single, elongated uterine horn with a single fallopian tube arising from it, consistent with a **unicornuate uterus**. - This congenital anomaly results from the **failure of one Müllerian duct to develop**, leading to an abnormally shaped uterus. *Septate uterus* - A **septate uterus** would show a normal uterine fundus with an internal septum dividing the uterine cavity. - This image clearly depicts only **one rudimentary horn** and no visible septum. *Uterus didelphys* - **Uterus didelphys** involves two completely separate uteri, each with its own cervix and vagina. - The image does not show evidence of a **second, separate uterine structure**. *Bicornuate uterus* - A **bicornuate uterus** is characterized by two distinct uterine horns, which fuse at the cervix or lower uterine segment, creating a heart-shaped appearance of the fundus. - The image shows a **single, long horn** rather than two distinct horns.

Question 3: Extramammary Paget's disease of the vulva is most commonly associated with which other cancer?

A. Vulvar cancer (Correct Answer)
B. Vaginal cancer
C. Cervical cancer
D. Uterine cancer

Explanation: ***Vulvar cancer*** - **Extramammary Paget's disease (EMPD)** frequently presents in the vulvar region and is associated with an underlying **adenocarcinoma** in up to 30% of cases. - The disease involves intraepithelial adenocarcinoma cells that can spread locally and, in some instances, indicates a synchronous or metachronous **internal malignancy**, often of genitourinary or gastrointestinal origin, but primarily vulvar adenocarcinoma in this context. *Vaginal cancer* - While Paget's disease can occur in other anogenital areas, its association with **primary vaginal cancer** is much less common compared to vulvar involvement. - **Vaginal Paget's disease** is rare and usually represents secondary spread from a vulvar primary or an underlying bladder/urethral carcinoma. *Cervical cancer* - **Paget's disease** is not typically associated with **cervical cancer**. Cervical cancers are predominantly squamous cell carcinomas or adenocarcinomas arising from the transformation zone. - While cervical adenocarcinoma can present with similar cells to Paget's, it is a distinct entity and not a common association. *Uterine cancer* - **Uterine cancer**, primarily endometrial carcinoma, has no direct or common association with **Paget's disease**. - Paget's disease primarily affects the skin and can be associated with underlying gland cancers, but these are generally in proximity to the epidermal involvement rather than distant uterine sites.

Question 4: What are the effects of Progesterone-only pills?

A. All of the options may occur (Correct Answer)
B. May suppress ovulation
C. Thins the lining of the uterus
D. Thickens cervical mucus

Explanation: ***All of the options may occur*** - Progesterone-only pills (POPs) work through **multiple complementary mechanisms** that collectively provide effective contraception. - All three effects occur simultaneously and contribute to the overall contraceptive efficacy of POPs. - Understanding these mechanisms helps explain why POPs are effective despite lower hormone doses compared to combined oral contraceptives. **Mechanism 1: May suppress ovulation** - POPs can **partially suppress ovulation**, preventing the release of an egg. - Traditional POPs suppress ovulation in approximately 40-60% of cycles, while newer desogestrel-containing POPs achieve higher rates (97-99%). - This effect depends on the dose and type of progestin used in the formulation. **Mechanism 2: Thins the lining of the uterus** - Progesterone causes **endometrial atrophy**, making the uterine lining thin and unsuitable for embryo implantation. - This hostile uterine environment acts as a backup contraceptive mechanism if ovulation and fertilization occur. - Endometrial changes occur consistently with POP use. **Mechanism 3: Thickens cervical mucus** - This is the **primary and most consistent mechanism** of POPs. - Progesterone significantly **increases cervical mucus viscosity** and reduces its quantity within hours of administration. - The thickened mucus creates a physical barrier that prevents sperm penetration, motility, and viability.

Question 5: Which of the following is not a high-risk pregnancy?

A. Age 25-30 years (Correct Answer)
B. Diabetes mellitus
C. Previous history of manual removal of placenta
D. Anemia

Explanation: ***Age 25-30 years*** - An age of **25-30 years** is generally considered the optimal reproductive age range, and pregnancies within this bracket are typically classified as low-risk based on age alone. - This age range carries the lowest statistical risk for both maternal and fetal complications, assuming no other co-morbidities. *Previous history of manual removal of placenta* - A previous history of manual removal of the placenta indicates a risk factor for **recurrent placental retention** or **morbidly adherent placenta** in future pregnancies, making it a high-risk factor. - This history suggests an increased likelihood of complications such as **postpartum hemorrhage** and can influence the management of subsequent deliveries. *Anemia* - **Anemia** in pregnancy, especially severe iron deficiency anemia, is considered a high-risk factor due to increased maternal and fetal morbidity. - It can lead to complications such as **preterm delivery**, **low birth weight**, and difficulties tolerating blood loss during delivery. *Diabetes mellitus* - **Diabetes mellitus**, whether pre-existing or gestational, makes a pregnancy high-risk due to potential adverse effects on both the mother and the fetus. - Risks include **preeclampsia**, **macrosomia**, **neonatal hypoglycemia**, and **congenital anomalies**.

Question 6: Which of the following methods is known as a fimbriectomy procedure?

A. Uchida procedure
B. Irving procedure
C. Madlener procedure
D. Kroener procedure (Correct Answer)

Explanation: ***Kroener procedure*** - The **Kroener procedure** is a method of **tubal ligation** particularly known as a **fimbriectomy**, where the fimbriated end of the fallopian tube is removed. - This sterilization technique primarily involves excising the **fimbriae**, preventing **ovum capture** and subsequent fertilization. *Uchida procedure* - The **Uchida procedure** involves **injecting a sclerosing solution** under the serosa of the fallopian tube, then excising a small segment and ligating the ends. - This method aims to **bury the fimbriated end** within the broad ligament, but it is not a fimbriectomy. *Irving procedure* - The **Irving procedure** involves **tying and transecting the fallopian tube**, then burying the severed medial end into the posterior wall of the uterus. - This technique is designed to prevent **fistula formation** and recanalization but does not involve fimbriectomy. *Madlener procedure* - The **Madlener procedure** involves **crushing a section** of the fallopian tube, usually a knuckle, and then ligating it. - This method is simpler but has a **higher failure rate** compared to other sterilization techniques and does not involve removal of the fimbriae.

Question 7: What is meant by Superfecundation?

A. Fertilization of ova and then its division
B. Fertilization of two or more ova in one intercourse
C. Fertilization of two or more ova in different intercourses in same menstrual cycle (Correct Answer)
D. Fertilization of second ovum after first one is already implanted

Explanation: ***Fertilization of two or more ova in different intercourses in same menstrual cycle*** - **Superfecundation** occurs when two or more ova released during the same menstrual cycle are fertilized by sperm from **separate acts of coitus**. - This can lead to **dizygotic twins** or multiples conceived at different times within a short window, potentially from different biological fathers. *Fertilization of two or more ova in one intercourse* - This scenario describes the fertilization of multiple ova within a **single sexual encounter**, often leading to **dizygotic multiples** but not superfecundation. - Superfecundation specifically implies fertilization from **separate instances of intercourse**. *Fertilization of ova and then its division* - This describes the formation of **monozygotic (identical) twins**, where a single fertilized ovum (zygote) later splits into two or more embryos. - It is distinct from superfecundation, which involves fertilization of **multiple ova**. *Fertilization of second ovum after first one is already implanted* - This describes **superfetation**, a rare phenomenon where a new pregnancy (fertilization and conception) occurs **while already pregnant** from a previous cycle. - Superfecundation, conversely, involves **multiple conceptions within the same menstrual cycle**, not across different cycles.

Question 8: Best time to perform the quadruple test is:

A. 8-12 weeks
B. 11-15 weeks
C. 15-20 weeks (Correct Answer)
D. 18-22 weeks

Explanation: ***15-20 weeks*** - The quadruple test measures levels of four substances (**alpha-fetoprotein**, **human chorionic gonadotropin**, **unconjugated estriol**, and **inhibin A**) in the mother's blood. - This window is optimal for detecting neural tube defects and chromosomal abnormalities like **Down syndrome** and **Trisomy 18**, allowing for timely counseling and further diagnostic testing if needed. *8-12 weeks* - This period is generally too early for the quadruple test to be accurate, as the levels of the markers would not be sufficiently distinct for reliable screening. - The **combined first-trimester screening** (nuchal translucency and blood tests for PAPP-A and hCG) is typically performed during this time. *11-15 weeks* - While some components might be detectable at the later end of this range, 15-20 weeks offers a more accurate window for all four markers of the quadruple test. - **Integrated screening**, which combines first and second-trimester markers, would involve blood draws around 10-14 weeks and then 15-20 weeks. *18-22 weeks* - This period is generally considered too late for optimal results of the quadruple test, as the fetal markers might be less indicative or diagnostic interventions options might be limited. - A **detailed ultrasound** for anatomical survey is usually performed around this time.

Question 9: Long-standing pelvic inflammatory disease (PID) may lead to which of the following complications?

A. Uterine polyposis
B. Hydrosalpinx (Correct Answer)
C. Endometriosis
D. Asherman syndrome

Explanation: ***Hydrosalpinx*** - **Hydrosalpinx** is a condition where the fallopian tube is blocked and filled with serous fluid, representing the **end-stage of chronic pelvic inflammatory disease (PID)**. - Chronic inflammation from **repeated or inadequately treated PID** causes damage to the tubal epithelium, loss of fimbrial function, and **adhesions that seal the distal end of the tube**. - This leads to accumulation of sterile transudate within the obstructed tube, creating a **fluid-filled, dilated fallopian tube**. - It is a major cause of **tubal factor infertility** and increased risk of **ectopic pregnancy**. - Classic imaging finding: **sausage-shaped cystic structure** on ultrasound. *Uterine polyposis* - **Endometrial polyps** are benign growths arising from the endometrium, typically associated with **unopposed estrogen stimulation** or hormonal imbalances. - They are **not a complication of chronic PID** but rather a proliferative endometrial disorder. - Common causes include obesity, tamoxifen use, and perimenopause. *Asherman syndrome* - **Asherman syndrome** involves **intrauterine adhesions** (synechiae) causing partial or complete obliteration of the uterine cavity. - It typically results from **endometrial trauma** following procedures like **D&C (dilatation and curettage)**, particularly post-abortion or postpartum curettage. - While PID can cause adhesions, Asherman syndrome specifically refers to **intrauterine** adhesions, not a typical sequela of chronic PID, which primarily affects the **tubes and ovaries**. *Endometriosis* - **Endometriosis** is the presence of **endometrial tissue outside the uterine cavity**, most commonly on ovaries, pelvic peritoneum, and uterosacral ligaments. - It is thought to result from **retrograde menstruation** (Sampson's theory) and genetic/immune factors. - It is **not caused by PID** but is a distinct pathological entity with different etiology and pathophysiology.

Question 10: Dilatation & curettage (D&C) is contraindicated in-

A. Pelvic inflammatory disease (PID) (Correct Answer)
B. Endometriosis
C. Ectopic pregnancy
D. Abnormal uterine bleeding

Explanation: ***Pelvic inflammatory disease (PID)*** - D&C is **contraindicated** in PID due to the high risk of **spreading pre-existing infection** from the cervix or vagina into the sterile uterine cavity and beyond. - This procedure can worsen the infection, potentially leading to **sepsis**, **tubo-ovarian abscesses**, or chronic pain. *Endometriosis* - D&C is not typically contraindicated in **endometriosis**, as it is sometimes used diagnostically to rule out other causes of abnormal uterine bleeding, though it isn't a treatment for endometriosis itself. - Endometriosis involves the presence of **endometrial tissue outside the uterus**, and a D&C performed on the uterus does not directly exacerbate this condition. *Ectopic pregnancy* - D&C is not contraindicated in **ectopic pregnancy**; however, it is not the primary treatment. - A D&C may be performed if the diagnosis of ectopic pregnancy is uncertain and to rule out an **intrauterine pregnancy** or retained products of conception. *Abnormal uterine bleeding* - D&C is frequently indicated and can be both **diagnostic and therapeutic** for abnormal uterine bleeding, especially to investigate causes like polyps, fibroids, or endometrial hyperplasia. - It helps in obtaining tissue for **histopathological examination** to guide further management.