NEET-PG 2012 — Obstetrics and Gynecology

Q: IUCD lasting for 10 years is a:

CuT - 380A. ***CuT - 380A*** - The **CuT-380A** is a copper-containing intrauterine device (IUD) specifically designed for a highly effective contraceptive duration of **10 years**. - Its mechanism involves the continuous release of copper ions, which create a hostile uterine environment for sperm and ova, preventing fertilization. *Progestase* - **Progestasert** (or Progestasert system) is a progesterone-releasing IUD that has a much **shorter duration of action**, typically around **1 year**. - Its contraceptive effect relies on the local release of progesterone, which thickens cervical mucus and thins the endometrial lining. *CuT - 220 (shorter duration)* - The **CuT-220** is an older generation copper IUD with a **shorter period of efficacy**, typically around **3 to 4 years**. - It contains a smaller surface area of copper compared to the CuT-380A, hence its shorter lifespan. *Nova T (shorter duration)* - **Nova T** is a copper IUD that is effective for a duration of **5 years**, making it a shorter-acting option compared to the CuT-380A. - While also copper-based, its design and total copper content allow for a more limited period of effectiveness. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Calcium requirement above the normal during the first six months of lactation is -

600 mg/day. ***600 mg/day*** - The increased calcium requirement during the first six months of lactation is primarily due to the significant amount of calcium secreted in **breast milk** for infant bone development. - During lactation, approximately **210-300 mg of calcium per day** is lost through breast milk, and considering **absorption efficiency** and maintaining maternal **bone density**, an additional **600 mg/day** above baseline requirements is recommended. - This additional intake helps meet the demands of milk production and prevent maternal bone demineralization during the period of **peak lactation**. *400 mg/day* - While calcium needs are elevated in lactation, an additional **400 mg/day** is insufficient to fully compensate for the calcium loss through breast milk during the initial, high-volume milk production phase. - This amount does not adequately account for both milk calcium content and the need to maintain maternal bone health during the first six months of lactation. *550 mg/day* - This increment is close but is generally considered slightly below the recommended additional intake for optimal maternal health and infant nutrition during **peak lactation**. - Adequate calcium intake is crucial as insufficient levels can lead to a negative calcium balance and increased risk of maternal **osteoporosis**. *75 mg/day* - An additional **75 mg/day** is a negligible increase and is far too low to meet the substantial calcium demands during the first six months of lactation. - This amount would be grossly inadequate considering that lactating mothers lose approximately **210-300 mg of calcium per day** into breast milk alone, not accounting for maternal physiological needs. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Blastocyst makes contact with endometrium on ?

5 - 7 days. ***5-7 days*** - The **blastocyst makes initial contact** (apposition) with the **endometrium** around **day 5-6 after fertilization**. - **Implantation**, which includes adhesion and invasion, typically begins around day 6 and is complete by day 10. - This timeframe allows the blastocyst to travel from the fallopian tube to the uterus and for the uterine lining to be optimally prepared. *< 3 days* - Within the first few days after fertilization, the zygote is still undergoing **cleavage** and development into a **morula**, then a young blastocyst, while traveling down the fallopian tube. - It has not yet reached the uterus or developed sufficiently to interact with the endometrium. *8-11 days* - By 8-11 days, the process of implantation is usually **well underway or completed**, with the blastocyst already invading the endometrial wall. - Initial contact and attachment occur prior to this period. *15-16 days* - This timeframe is well beyond the typical window for initial blastocyst contact and implantation. - By 15-16 days post-fertilization, the embryo would be undergoing **gastrulation** and early organogenesis, assuming successful implantation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which structure do cytotrophoblasts invade during implantation?

Decidua basalis. ***Decidua basalis*** - The **cytotrophoblasts** invade the maternal **decidua basalis**, which is the portion of the **endometrium** directly underlying the implanted embryo, forming the maternal component of the **placenta**. - This invasion is crucial for establishing the **placenta** and allowing for nutrient and waste exchange between the mother and the fetus. *Decidua parietalis* - The **decidua parietalis** is the portion of the **endometrium** lining the rest of the **uterine cavity**, not directly involved in the immediate implantation site. - It plays a role later in pregnancy, fusing with the **decidua capsularis** as the **embryo** grows. *Decidua capsularis* - The **decidua capsularis** is the portion of the endometrium that overlies the implanted embryo, separating it from the uterine lumen. - It does not undergo invasion by the **cytotrophoblasts** in the same way the **decidua basalis** does. *Decidua vera* - The **decidua vera** is another term for the **decidua parietalis**, referring to the endometrial lining of the uterine cavity that is not involved in the implantation site. - It is not directly invaded by **cytotrophoblasts** during implantation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: The thickness of the endometrium at the time of implantation is:

7 - 10 mm. ***7 - 10 mm*** - At the time of **implantation** (day 6-10 post-fertilization, around day 20-24 of the menstrual cycle), the endometrium is in the **mid-secretory phase** and measures **7-10 mm** in thickness. - This is the **optimal thickness** for successful embryo implantation, characterized by a receptive endometrium with **decidualization**, **spiral artery development**, and **glycogen-rich glandular secretions**. - Endometrial thickness <7 mm is associated with **poor implantation rates** and reduced pregnancy success. *3 - 4 mm* - An endometrial thickness of 3-4 mm is **too thin** for successful implantation. - This thickness is typically seen in the **early proliferative phase** (immediately after menstruation), not during the implantation window. - Thin endometrium (<7 mm) is associated with **poor receptivity** and lower pregnancy rates in both natural conception and assisted reproduction. *20 - 30 mm* - An endometrial thickness of 20-30 mm is **abnormally thick** and not conducive to normal implantation. - Such thickness may indicate **endometrial hyperplasia**, **polyps**, or other pathological conditions requiring investigation. *30 - 40 mm* - An endometrial thickness of 30-40 mm is **severely abnormal** and would likely prevent successful implantation. - This extreme thickness suggests significant pathology such as **endometrial hyperplasia** or **malignancy** and requires urgent evaluation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

71 Previous Year Questions with Answers & Explanations

Questions

IUCD lasting for 10 years is a:

Calcium requirement above the normal during the first six months of lactation is -

Blastocyst makes contact with endometrium on ?

Which structure do cytotrophoblasts invade during implantation?

The thickness of the endometrium at the time of implantation is:

In which period is maternal mortality highest?

When should breastfeeding be initiated after a normal delivery?

Which contraceptive method has the lowest pregnancy failure rate (typical use)?

What is the energy requirement in late pregnancy?

Q10

Rule of Hasse is used to determine :

NEET-PG 2012 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs

Question 1: IUCD lasting for 10 years is a:

A. CuT - 380A (Correct Answer)
B. Nova T
C. CuT - 220
D. Progestasert

Explanation: ***CuT - 380A*** - The **CuT-380A** is a copper-containing intrauterine device (IUD) specifically designed for a highly effective contraceptive duration of **10 years**. - Its mechanism involves the continuous release of copper ions, which create a hostile uterine environment for sperm and ova, preventing fertilization. *Progestase* - **Progestasert** (or Progestasert system) is a progesterone-releasing IUD that has a much **shorter duration of action**, typically around **1 year**. - Its contraceptive effect relies on the local release of progesterone, which thickens cervical mucus and thins the endometrial lining. *CuT - 220 (shorter duration)* - The **CuT-220** is an older generation copper IUD with a **shorter period of efficacy**, typically around **3 to 4 years**. - It contains a smaller surface area of copper compared to the CuT-380A, hence its shorter lifespan. *Nova T (shorter duration)* - **Nova T** is a copper IUD that is effective for a duration of **5 years**, making it a shorter-acting option compared to the CuT-380A. - While also copper-based, its design and total copper content allow for a more limited period of effectiveness.

Question 2: Calcium requirement above the normal during the first six months of lactation is -

A. 75 mg/day
B. 400 mg/day
C. 550 mg/day
D. 600 mg/day (Correct Answer)

Explanation: ***600 mg/day*** - The increased calcium requirement during the first six months of lactation is primarily due to the significant amount of calcium secreted in **breast milk** for infant bone development. - During lactation, approximately **210-300 mg of calcium per day** is lost through breast milk, and considering **absorption efficiency** and maintaining maternal **bone density**, an additional **600 mg/day** above baseline requirements is recommended. - This additional intake helps meet the demands of milk production and prevent maternal bone demineralization during the period of **peak lactation**. *400 mg/day* - While calcium needs are elevated in lactation, an additional **400 mg/day** is insufficient to fully compensate for the calcium loss through breast milk during the initial, high-volume milk production phase. - This amount does not adequately account for both milk calcium content and the need to maintain maternal bone health during the first six months of lactation. *550 mg/day* - This increment is close but is generally considered slightly below the recommended additional intake for optimal maternal health and infant nutrition during **peak lactation**. - Adequate calcium intake is crucial as insufficient levels can lead to a negative calcium balance and increased risk of maternal **osteoporosis**. *75 mg/day* - An additional **75 mg/day** is a negligible increase and is far too low to meet the substantial calcium demands during the first six months of lactation. - This amount would be grossly inadequate considering that lactating mothers lose approximately **210-300 mg of calcium per day** into breast milk alone, not accounting for maternal physiological needs.

Question 3: Blastocyst makes contact with endometrium on ?

A. < 3 days
B. 5 - 7 days (Correct Answer)
C. 8 - 11 days
D. 15-16 days

Explanation: ***5-7 days*** - The **blastocyst makes initial contact** (apposition) with the **endometrium** around **day 5-6 after fertilization**. - **Implantation**, which includes adhesion and invasion, typically begins around day 6 and is complete by day 10. - This timeframe allows the blastocyst to travel from the fallopian tube to the uterus and for the uterine lining to be optimally prepared. *< 3 days* - Within the first few days after fertilization, the zygote is still undergoing **cleavage** and development into a **morula**, then a young blastocyst, while traveling down the fallopian tube. - It has not yet reached the uterus or developed sufficiently to interact with the endometrium. *8-11 days* - By 8-11 days, the process of implantation is usually **well underway or completed**, with the blastocyst already invading the endometrial wall. - Initial contact and attachment occur prior to this period. *15-16 days* - This timeframe is well beyond the typical window for initial blastocyst contact and implantation. - By 15-16 days post-fertilization, the embryo would be undergoing **gastrulation** and early organogenesis, assuming successful implantation.

Question 4: Which structure do cytotrophoblasts invade during implantation?

A. Decidua capsularis
B. Decidua vera
C. Decidua basalis (Correct Answer)
D. Decidua parietalis

Explanation: ***Decidua basalis*** - The **cytotrophoblasts** invade the maternal **decidua basalis**, which is the portion of the **endometrium** directly underlying the implanted embryo, forming the maternal component of the **placenta**. - This invasion is crucial for establishing the **placenta** and allowing for nutrient and waste exchange between the mother and the fetus. *Decidua parietalis* - The **decidua parietalis** is the portion of the **endometrium** lining the rest of the **uterine cavity**, not directly involved in the immediate implantation site. - It plays a role later in pregnancy, fusing with the **decidua capsularis** as the **embryo** grows. *Decidua capsularis* - The **decidua capsularis** is the portion of the endometrium that overlies the implanted embryo, separating it from the uterine lumen. - It does not undergo invasion by the **cytotrophoblasts** in the same way the **decidua basalis** does. *Decidua vera* - The **decidua vera** is another term for the **decidua parietalis**, referring to the endometrial lining of the uterine cavity that is not involved in the implantation site. - It is not directly invaded by **cytotrophoblasts** during implantation.

Question 5: The thickness of the endometrium at the time of implantation is:

A. 7 - 10 mm (Correct Answer)
B. 20 - 30 mm
C. 30 - 40 mm
D. 3 - 4 mm

Explanation: ***7 - 10 mm*** - At the time of **implantation** (day 6-10 post-fertilization, around day 20-24 of the menstrual cycle), the endometrium is in the **mid-secretory phase** and measures **7-10 mm** in thickness. - This is the **optimal thickness** for successful embryo implantation, characterized by a receptive endometrium with **decidualization**, **spiral artery development**, and **glycogen-rich glandular secretions**. - Endometrial thickness <7 mm is associated with **poor implantation rates** and reduced pregnancy success. *3 - 4 mm* - An endometrial thickness of 3-4 mm is **too thin** for successful implantation. - This thickness is typically seen in the **early proliferative phase** (immediately after menstruation), not during the implantation window. - Thin endometrium (<7 mm) is associated with **poor receptivity** and lower pregnancy rates in both natural conception and assisted reproduction. *20 - 30 mm* - An endometrial thickness of 20-30 mm is **abnormally thick** and not conducive to normal implantation. - Such thickness may indicate **endometrial hyperplasia**, **polyps**, or other pathological conditions requiring investigation. *30 - 40 mm* - An endometrial thickness of 30-40 mm is **severely abnormal** and would likely prevent successful implantation. - This extreme thickness suggests significant pathology such as **endometrial hyperplasia** or **malignancy** and requires urgent evaluation.

Question 6: In which period is maternal mortality highest?

A. Antepartum
B. Peripartum (Correct Answer)
C. Postpartum
D. No period of maximum risk

Explanation: ***Peripartum*** - The peripartum period encompasses the time immediately before, during, and after childbirth, when the risks of **hemorrhage, infection, pre-eclampsia/eclampsia**, and other **acute obstetric complications** are highest. - The **physiological stresses** of labor and delivery, coupled with potential complications like **uterine atony** or **obstructed labor**, contribute significantly to maternal mortality during this critical window [2]. *Antepartum* - While complications like **severe pre-eclampsia, ectopic pregnancy**, and chronic conditions can occur during the antepartum period, the **acute risks of hemorrhage and infection** are generally lower than during and immediately after delivery [1]. - Most maternal deaths occurring antepartum are due to conditions that ultimately lead to or manifest more severely during the peripartum or postpartum phases, such as undetected pre-eclampsia worsening to eclampsia [3]. *Postpartum* - The postpartum period (especially the first 42 days) also carries significant risks such as **late postpartum hemorrhage, puerperal sepsis, and thromboembolism** [2]. - While substantial, the **magnitude of mortality risk** primarily due to acute events related to labor and delivery (e.g., massive hemorrhage, amniotic fluid embolism) is often concentrated in the peripartum period [2]. *No period of maximum risk* - This statement is incorrect because maternal mortality risk is demonstrably **higher during specific periods** related to pregnancy and childbirth, rather than being evenly distributed [1]. - The physiological changes and obstetric challenges associated with gestation, labor, and the puerperium create distinct periods of elevated risk for maternal morbidity and mortality.

Question 7: When should breastfeeding be initiated after a normal delivery?

A. 2 hours after delivery
B. 4 hours after delivery
C. 6 hours after delivery
D. Immediately after delivery (Correct Answer)

Explanation: **Correct: Immediately after delivery** - Initiating breastfeeding **within the first hour** of birth (early initiation) is crucial for establishing **successful lactation** and promoting optimal infant health. - This early initiation allows for **skin-to-skin contact**, which helps stabilize the newborn's temperature, heart rate, and breathing, and facilitates **bonding** between mother and baby. - Aligned with **WHO and UNICEF recommendations** for best practice in postpartum care. *Incorrect: 2 hours after delivery* - While earlier is generally better, waiting two hours misses the **optimal window** for initiating feeding and bonding. - The newborn's **alert period** is typically strongest in the first hour post-birth, making it an ideal time for the first latch. *Incorrect: 4 hours after delivery* - Delaying breastfeeding by four hours can make it more challenging for the baby to latch effectively as they may have passed their **initial alert state** and become sleepy. - This delay can also hinder the establishment of the mother's **milk supply**, as stimulation from early feeding is important for prolactin release. *Incorrect: 6 hours after delivery* - Waiting six hours significantly **misses the critical window** for early initiation and can lead to increased difficulties with breastfeeding. - Prolonged delays may necessitate supplementation, potentially interfering with exclusive breastfeeding and establishing a **strong milk supply**.

Question 8: Which contraceptive method has the lowest pregnancy failure rate (typical use)?

A. Diaphragm
B. Condom
C. Intrauterine Contraceptive Device (IUCD) (Correct Answer)
D. Oral Contraceptive Pills (OCP)

Explanation: ***Intrauterine Contraceptive Device (IUCD)*** - **IUCDs** are highly effective, with a **pregnancy failure rate of less than 1%** in typical use due to their long-acting and reversible nature, requiring no daily action from the user. - They are **fit-and-forget methods**, eliminating user error inherent in other forms of contraception, leading to very low typical use failure rates. *Diaphragm* - The **diaphragm** has a significantly higher typical use failure rate (around 12-16%) because its effectiveness depends on **correct placement** and consistent use with spermicide before each intercourse. - It is a **user-dependent method**, making its efficacy susceptible to improper use or non-use during sexual activity. *Condom* - **Condoms** have a typical use failure rate of about 13-18%, largely due to **incorrect use**, breakage, or slippage. - Their effectiveness relies heavily on **consistent and proper application** with every act of intercourse. *Oral Contraceptive Pills (OCP)* - **Oral Contraceptive Pills (OCPs)** have a typical use failure rate of approximately 7-9%, primarily because effectiveness is dependent on **daily adherence** at roughly the same time. - **Missed pills** are a common reason for failure, significantly increasing the risk of pregnancy compared to methods that do not require daily action.

Question 9: What is the energy requirement in late pregnancy?

A. 2000 calories
B. 2500 calories (Correct Answer)
C. 1400 calories
D. 3000 calories

Explanation: ***2500 calories*** - The energy requirement for women in late pregnancy (third trimester) is approximately **2300-2500 calories per day**, which includes an additional **300-450 calories** above pre-pregnancy needs. - This increased energy intake supports **fetal growth and development**, increased maternal blood volume, uterine growth, and the metabolic demands of pregnancy. - The **2500 calorie** recommendation represents the upper range suitable for most pregnant women with normal activity levels. *2000 calories* - This amount is closer to the **pre-pregnancy energy requirement** for an average woman, but is **insufficient** for late pregnancy. - During the third trimester, failing to meet increased caloric needs can compromise **fetal growth** and lead to **inadequate gestational weight gain**. *1400 calories* - This amount is **severely insufficient** for the increased metabolic demands of late pregnancy. - An inadequate calorie intake can compromise **fetal growth**, lead to **intrauterine growth restriction (IUGR)**, and cause **maternal nutrient deficiencies**. *3000 calories* - This caloric intake is generally **too high** for the average pregnant woman with normal activity levels. - Excessive intake is only justified in cases of **multiple gestation**, unusually high physical activity, or specific medical conditions. - Consuming 3000 calories per day without proper justification can lead to **excessive gestational weight gain**, gestational diabetes, and macrosomia.

Question 10: Rule of Hasse is used to determine :

A. Height of an adult.
B. Race of a person.
C. Identification of fetal abnormalities.
D. Age of the fetus (Correct Answer)

Explanation: ***Age of the fetus*** - **Hasse's Rule** is a forensic pathology method used to estimate the **age of a dead fetus** (stillborn or aborted fetus) based on its physical length. - The rule states: **For months 1-5**: Age in months = Length in cm; **For months 6-10**: Age in months = Length in cm ÷ 5 - This is primarily used in **medico-legal contexts** and post-mortem examinations, not in routine obstetric practice. - The measurement is taken from **crown to heel** of the deceased fetus. *Height of an adult* - Hasse's Rule is specifically for estimating **fetal age** in forensic settings, not for determining adult height. - Adult height is determined by genetics, nutrition, and growth patterns during development. *Race of a person* - This rule is used solely for **fetal age estimation** in post-mortem examinations. - It has no application in determining racial characteristics. *Identification of fetal abnormalities* - Hasse's Rule is a **dating method** for deceased fetuses, not a diagnostic tool for abnormalities. - Fetal abnormalities are identified through detailed anatomical examination, imaging studies, and other specific diagnostic methods.