NEET-PG 2024 - Obstetrics and Gynecology PYQs Practice Questions

Q: The flexion point in ventouse (vacuum) delivery is located at:

3 cm anterior to the posterior fontanelle. ***3 cm anterior to the posterior fontanelle*** - This is the **correct location of the flexion point** (also described as approximately 6 cm posterior to the anterior fontanelle along the sagittal suture). - This position optimizes the **flexion-traction axis** during vacuum extraction, ensuring that the fetal head descends through the birth canal in the most favorable attitude with maximum flexion. - Correct placement of the vacuum cup at this site provides a **mechanical advantage**, leveraging the natural pivot point of the fetal head for effective delivery and bringing the **occiput** down first. *3 cm posterior to the anterior fontanelle* - This location is **too far anterior**, only 3 cm from the anterior fontanelle, and does not correspond to the true flexion point. - Placing the cup here would result in **suboptimal flexion** and poor mechanical advantage during traction. - This may lead to **cup slippage**, increased rate of failed vacuum delivery, and potential scalp injury. *6 cm anterior to the posterior fontanelle* - Since the distance between fontanelles is approximately 9 cm, this position would be equivalent to 3 cm posterior to the anterior fontanelle (too anterior). - This is **not the correct flexion point** and would result in the same problems as placing the cup too far anterior. *Midway between the anterior and posterior fontanelle* - While this location (approximately 4.5 cm from either fontanelle) might seem intuitive, it does not precisely correspond to the optimal **flexion point** for vacuum extraction. - The true flexion point is slightly more posterior, at **3 cm anterior to the posterior fontanelle**, which optimizes the mechanism of labor. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Identify the instrument shown in the image below:

Kielland. ***Kielland*** - Kielland forceps are distinguished by their **lack of pelvic curve** and the presence of a sliding lock mechanism designed for **rotation of the fetal head**. - They are primarily used for **rotational delivery** when the fetal head is in malposition, often in the mid-pelvis. *Simpson* - Simpson forceps have a distinct **cephalic curve** for grasping the fetal head and a **pelvic curve** to conform to the birth canal. - They are commonly used for **outlet and low-cavity deliveries** where minimal rotation is needed. *Wrigley* - Wrigley forceps are a type of **outlet forceps** with a very short shanks and blades, making them suitable only when the fetal head is on the **perineum**. - They are designed for situations where the head is already visible without separating the labia. *Pipers* - Pipers forceps are specifically designed for **delivery of the after-coming head in breech presentations**. - They feature a long, curved shank that allows placement from below the maternal pelvis to grasp the fetal head in this particular presentation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which of the following is not a contraindication for External Cephalic Version (ECV)?

Primigravida. ***Primigravida*** - Being a **primigravida** (first pregnancy) is not a contraindication for ECV, though it might be associated with a slightly lower success rate compared to multiparous women due to a less pliable uterus. - While it may indicate a potentially more challenging ECV due to higher uterine tone, it does not preclude the procedure if other conditions are favorable. *Placenta previa* - **Placenta previa** is a contraindication because the manipulation of the uterus during ECV could dislodge the placenta, leading to **severe hemorrhage** and potential fetal compromise. - This condition involves the placenta covering the cervical opening, making any uterine intervention risky. *Twin pregnancy* - **Twin pregnancy** is a contraindication as ECV is generally not recommended in multiple gestations due to increased complexity and risk of complications. - The risk of **umbilical cord entanglement**, disruption of twin positioning, and potential harm to either fetus makes ECV unsafe in twin pregnancies. *PROM (Premature Rupture of Membranes)* - **Premature Rupture of Membranes (PROM)** is a contraindication due to the increased risk of uterine infection and **cord prolapse** during manipulation. - Once membranes are ruptured, the natural cushioning provided by the amniotic fluid is lost, making ECV potentially traumatic for both the mother and the fetus. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 30-year-old female, G2L2, with a history of cervical elongation presents for surgical consultation. What is the surgery of choice?

Fothergill. **Fothergill** - The Fothergill operation, or **Manchester procedure**, is a surgical technique used for **cervical elongation** and **genital prolapse**, specifically involving suspension of the cardinal ligaments and cervical amputation. - This procedure addresses both the elongated cervix and associated pelvic organ prolapse without removing the uterus, making it suitable for women who wish to retain their uterus. *McCall* - The McCall culdoplasty is primarily performed to correct **vaginal vault prolapse** and is typically done during a hysterectomy or for post-hysterectomy prolapse. - It involves plicating the uterosacral ligaments to provide support to the vaginal vault; it does not directly address cervical elongation. *Lefort* - The Lefort colpocleisis is a **partial vaginal closure** procedure performed for severe pelvic organ prolapse in elderly women who are no longer sexually active. - This operation reduces symptoms of prolapse but closes off a significant portion of the vagina, making it unsuitable for sexually active patients or those desiring uterine preservation for fertility. *Hysterectomy* - A hysterectomy involves the **surgical removal of the uterus**, which would address cervical elongation by default as the cervix is part of the uterus. - However, for a 30-year-old female who may wish to retain reproductive function or avoid an extensive surgery if other options are available, hysterectomy is usually not the first-line choice for isolated cervical elongation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A pregnant woman presents with an IUD in place, and the thread is clearly visible. She wishes to continue the pregnancy. What is the most appropriate next step?

Remove gently. ***Remove gently*** - When the **IUD thread is visible**, gentle removal is recommended if the woman wishes to **continue the pregnancy**, as this significantly reduces the risk of miscarriage and infection. - Leaving an **IUD in situ** during pregnancy increases risks of **septic miscarriage**, **preterm delivery**, and **chorioamnionitis**. *Leave the IUD inside* - Leaving an **IUD in place** during pregnancy increases the risks of **septic miscarriage**, **chorioamnionitis**, and **preterm labor**. - The presence of the IUD can also lead to **placental complications** and difficulties with fetal development. *MTP (Medical Termination of Pregnancy)* - MTP is an option for unintended pregnancies but is not the most appropriate first step when the patient explicitly **wishes to continue the pregnancy**. - MTP would be considered if the patient chose to terminate, but the question states she wants to continue. *Cesarean section* - **Cesarean section** is a mode of delivery and is not an appropriate initial intervention for an early pregnancy with an **IUD in situ**. - The removal of an IUD from an early pregnancy does not necessitate a cesarean section. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

The flexion point in ventouse (vacuum) delivery is located at:

Accepted Answer

3 cm anterior to the posterior fontanelle

Answer

3 cm posterior to the anterior fontanelle

Answer

6 cm anterior to the posterior fontanelle

Answer

Midway between the anterior and posterior fontanelle

Question 2

Identify the instrument shown in the image below:

Accepted Answer

Kielland

Answer

Simpson

Answer

Wrigley

Answer

Pipers

Question 3

Which of the following is not a contraindication for External Cephalic Version (ECV)?

Accepted Answer

Primigravida

Answer

Placenta previa

Answer

Twin pregnancy

Answer

PROM (Premature Rupture of Membranes)

Question 4

A 30-year-old female, G2L2, with a history of cervical elongation presents for surgical consultation. What is the surgery of choice?

Accepted Answer

Fothergill

Answer

McCall

Answer

Lefort

Answer

Hysterectomy

Question 5

A pregnant woman presents with an IUD in place, and the thread is clearly visible. She wishes to continue the pregnancy. What is the most appropriate next step?

Accepted Answer

Remove gently

Answer

Leave the IUD inside

Answer

MTP (Medical Termination of Pregnancy)

Answer

Cesarean section

Question 6

A woman at 30 weeks of gestation is diagnosed with deep vein thrombosis (DVT). Which of the following is the most appropriate treatment for this patient?

Accepted Answer

Low Molecular Weight Heparin (LMWH)

Answer

Warfarin

Answer

Apixaban

Answer

Fondaparinux

Question 7

A patient with eclampsia is being treated with magnesium sulfate. Which of the following is an indication to stop the drug?

Accepted Answer

Urine output less than 100 ml in 4 hours

Answer

Respiratory rate more than 18 per minute

Answer

Exaggerated deep tendon reflexes

Answer

Presence of visual disturbances

Question 8

A pregnant female at 37 weeks of gestation with a history of prosthetic heart valves is currently taking warfarin. She comes for a routine antenatal check-up. What is the appropriate management advice?

Accepted Answer

Switch to low molecular weight heparin

Answer

Immediate induction of labor

Answer

Perform LSCS (Lower Segment Cesarean Section)

Answer

Continue the same medication

Question 9

A 14-year-old victim of sexual assault with 22 weeks gestation has been brought for Medical Termination of Pregnancy (MTP). Which of the following statements is true?

Accepted Answer

MTP can be carried out up to 24 weeks

Answer

One doctor is involved

Answer

MTP done in 2nd trimester only when mother's life is in danger

Answer

MTP cannot be more than 20 weeks

Question 10

A pregnant lady delivers a healthy baby via normal delivery. What is the earliest time at which an intrauterine contraceptive device (IUCD) can be inserted?

Accepted Answer

Within 48 hours

Answer

After 6 weeks

Answer

After 3 months

Answer

After 1 month

NEET-PG 2024 — Obstetrics and Gynecology