NEET-PG 2012 - Obstetrics and Gynecology Practice Questions

Q: Palmer sign is related to ?

Uterine contractions palpable through rectum during labor. ***Uterine contractions palpable through rectum during labor*** - **Palmer sign** refers to the palpation of **uterine contractions** through the rectum, particularly during the early stages of labor or even in simulated labor pains. - This sign is an indicator used to assess uterine activity, especially when vaginal examination might be less informative or desired. *Softening of the cervix during pregnancy* - This describes **Goodell's sign**, which is caused by increased vascularity and edema of the cervix during early pregnancy. - While an important sign of pregnancy, it is not referred to as Palmer sign. *Bluish discoloration of cervix and vagina* - This phenomenon is known as **Chadwick's sign**, resulting from increased blood flow to the reproductive organs during pregnancy. - It is an early indication of pregnancy but distinct from the uterine contraction palpation. *Increased pulsations in uterine arteries* - This is known as **Osiander’s sign** or **uterine souffle**, characterized by a soft blowing sound over the uterus due to increased blood flow through the uterine arteries. - It is a vascular sign of pregnancy and not related to uterine contractions felt rectally.

Q: What is the stage of endometrial carcinoma when it involves the cervix?

Stage 2: Cancer has spread to the cervix.. ***Stage 2: Cancer has spread to the cervix*** - According to the **FIGO 2009 staging system** for endometrial carcinoma (applicable at the time of this exam), involvement of the cervix with **stromal invasion** without extending beyond the uterus into the parametrium is classified as **Stage II**. - This stage indicates that the cancer remains within the confines of the uterus but has spread from the uterine corpus to the **cervical stroma**. - **Note:** FIGO staging was updated in 2023, but this question reflects the 2009 criteria used at the time. *Stage 1: Cancer confined to the uterus* - This stage indicates that the cancer is **limited to the uterine corpus (body of the uterus)**, with no spread to the cervix or beyond. - Stage 1 is further subdivided based on the **depth of myometrial invasion**, but the cervix is not involved at this stage. *Stage 3: Cancer has spread beyond the uterus but not beyond the pelvis* - Stage 3 involves spread **beyond the uterus but is still confined to the pelvis**, including parametrial involvement, vaginal or serosal invasion, or pelvic/paraaortic lymph node involvement. - This stage represents more extensive local or regional spread than simply cervical involvement. *Stage 4: Cancer has spread to distant sites* - This is the most advanced stage, indicating that the cancer has spread to **distant organs** (e.g., lungs, bone) or involves the **bladder or bowel mucosa**. - Stage 4 represents a systemic disease rather than localized pelvic spread.

Q: What is the treatment of choice for Bartholin's cyst?

Marsupialization. ***Marsupialization*** - This procedure involves incising the cyst, draining its contents, and then everting and suturing the edges of the cyst wall to the surrounding skin, creating a permanent-draining pouch. - **Marsupialization** is the treatment of choice because it prevents recurrence by allowing continuous drainage of mucus, unlike simple incision and drainage. *Excision* - Complete surgical excision of the Bartholin's gland or cyst is a more invasive procedure and is typically reserved for cases of **recurrent cysts** after marsupialization or suspected malignancy. - It carries a higher risk of bleeding and infection compared to marsupialization, and can lead to **vaginal dryness** due to loss of glandular secretions. *Antibiotic therapy* - Antibiotics are primarily used if the Bartholin's gland becomes **infected**, leading to an **abscess**, or if there is surrounding cellulitis. - They do not address the underlying blockage of the duct and will not resolve a Bartholin's cyst, which is a collection of mucus due to duct obstruction. *Cyst drainage* - Simple incision and drainage (I&D) provides temporary relief by emptying the cyst contents but has a **high recurrence rate** because the duct often re-occludes. - While it may be used as an initial temporizing measure, it is not the definitive treatment for preventing future episodes of Bartholin's cysts.

Q: Tdap vaccine is given in between which weeks of pregnancy?

27-36 weeks. ***27-36 weeks*** - The **Tdap vaccine** is recommended during this window in **every pregnancy** to maximize the transfer of **maternal antibodies** to the fetus. - This timing provides effective protection against **pertussis (whooping cough)** for the newborn from birth until their own vaccinations begin. *10-16 weeks* - This period is generally too early for optimal **passive immunity transfer** to the fetus against pertussis. - While other vaccines might be considered, **Tdap is specifically timed later** for maximum antibody benefit. *17-22 weeks* - This window is also typically considered too early for the Tdap vaccine to provide the **highest level of antibody transfer** to the newborn. - The goal is to administer the vaccine when **maternal antibody levels peak closer to delivery**. *22-26 weeks* - While closer to the recommended timeframe, this still falls slightly outside the **optimal window (27-36 weeks)** for the Tdap vaccine. - Delaying slightly longer ensures **peak antibody levels** for the longest possible passive immunity.

Q: What is the most common complication that can arise from vacuum delivery during childbirth?

Cephalohematoma. ***Cephalohematoma*** - A cephalohematoma is a collection of blood between the **periosteum and the skull bone**, typically forming over the parietal bone. - It is the **most common complication** of vacuum delivery, occurring in **6-26% of vacuum-assisted deliveries**. - It presents as a firm, fluctuant swelling that **does not cross suture lines** and typically appears several hours after delivery. - Usually **self-limiting** and resolves spontaneously over weeks to months, though it may be associated with hyperbilirubinemia. *Subgaleal hemorrhage* - This is a more serious but **less common** complication (0.4-0.6% incidence) involving bleeding into the **potential space between the galea aponeurotica and the periosteum**. - Can lead to significant blood loss and hypovolemic shock due to the large potential space that can accommodate substantial blood volume. - Requires immediate recognition and management, but its lower incidence makes it less common than cephalohematoma. *Scalp lacerations* - Occur in approximately **13% of vacuum deliveries** but are less common than cephalohematoma. - Typically superficial and heal well with minimal intervention. - Result from the rim of the vacuum cup causing trauma to the scalp tissue. *Retinal hemorrhages* - Occur in up to **40-50% of all vaginal deliveries** (both spontaneous and assisted), making them common but not specific to vacuum delivery. - Usually **asymptomatic and self-limiting**, resolving within days to weeks without sequelae. - While common, cephalohematoma remains the most frequently documented **specific complication** of vacuum extraction.

Q: All are causes of anovulatory amenorrhea except which of the following?

Gonadal dysgenesis. ***Gonadal dysgenesis*** - This condition is a cause of **primary ovarian insufficiency**, leading to amenorrhea but not primarily due to anovulation in a previously cycling individual. - In gonadal dysgenesis, the **ovaries are malformed or absent**, resulting in a lack of follicles and thus no ovulation or estrogen production from the start. *PCOD* - **Polycystic Ovarian Disease** (PCOD/PCOS) is a common cause of anovulatory amenorrhea, characterized by **oligo- or anovulation**, clinical or biochemical hyperandrogenism, and polycystic ovaries on ultrasound. - The hormonal imbalance (e.g., elevated **androgens**, high **LH/FSH ratio**) disrupts normal follicular development and ovulation. *Hyperprolactinemia* - **Elevated prolactin levels** inhibit the pulsatile secretion of **GnRH (Gonadotropin-Releasing Hormone)** from the hypothalamus, which in turn reduces FSH and LH release from the pituitary. - This suppression of gonadotropins leads to impaired follicular development and **anovulation**, resulting in amenorrhea. *Drugs* - Various medications can cause anovulatory amenorrhea by interfering with the **hypothalamic-pituitary-ovarian axis**. - Examples include antipsychotics (which can increase **prolactin levels**), certain antidepressants, opioids, and chemotherapy agents that can damage ovarian function.

Q: Which structure is least likely to be injured during common gynecological procedures?

Renal pelvis. ***Renal pelvis*** - The **renal pelvis** is anatomically distant from the surgical fields of most common gynecological procedures, making injury unlikely. - Its protected position deep within the abdominal cavity, surrounded by fat and muscle, generally shields it from inadvertent trauma during pelvic surgery. *Ureter at pelvic brim* - The **ureter** crosses the **pelvic brim**, an area often involved in gynecological dissections, especially during procedures like **pelvic lymphadenectomy** or management of large masses. - It is susceptible to injury during instrumentation or clamping in this region due to its close proximity to pelvic vessels. *Urinary bladder* - The **urinary bladder** is frequently in the surgical field during gynecological procedures, particularly those involving the anterior vaginal wall, cervix, or uterus (e.g., **hysterectomy**, **cystocele repair**). - Its thin wall and close proximity make it vulnerable to perforation, laceration, or thermal injury. *Ureter at infundibulopelvic ligament* - The **ureter** passes perilously close to the **infundibulopelvic ligament** (suspensory ligament of the ovary) as it enters the pelvis. - This area is frequently ligated or clamped during **oophorectomy** or adnexal mass removal, placing the ureter at high risk of kinking, ligation, or transection.

Q: Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Most common is ascending infection. ***Most common is ascending infection*** - Uterine tuberculosis is overwhelmingly due to **hematogenous spread** from a primary site, often the lungs, rather than an ascending infection from the lower genital tract. - Tuberculosis typically reaches the female genital tract by the **bloodstream**, with the fallopian tubes being the most common initial site of involvement. *Mostly secondary* - Genital tuberculosis, including uterine involvement, is almost always a **secondary infection**, meaning it results from the spread of Mycobacterium tuberculosis from another primary site in the body, most commonly the lungs. - The initial infection establishes elsewhere, and then the bacteria **disseminate hematogenously** to the reproductive organs. *Increase incidence of ectopic pregnancy* - Tubal damage and scarring caused by tuberculosis, particularly in the fallopian tubes (**salpingitis**), disrupt the normal passage of the ovum. - This anatomical alteration significantly **increases the risk** of the fertilized egg implanting outside the uterus, leading to ectopic pregnancy. *Involvement of endosalpinx* - The **fallopian tubes (endosalpinx)** are the most common site of genital tuberculosis, with eventual spread to the uterus through the lymphatic system or direct extension. - Tubal involvement can lead to **salpingitis isthmica nodosa** and hydrosalpinx, contributing to infertility and ectopic pregnancy.

Q: Gold standard technique for diagnosis of endometriosis?

Laparoscopy. ***Laparoscopy*** - **Laparoscopy** allows for direct visualization of endometrial implants and enables **biopsy confirmation**, making it the gold standard. - This minimally invasive surgical procedure is crucial for diagnosing, staging, and often treating endometriosis simultaneously. *Ca 125 level* - **CA-125** is a serum marker that can be elevated in endometriosis, but it is **not specific** and can be raised in other conditions like ovarian cancer or physiologic states. - It is primarily used for monitoring treatment response or recurrence, rather than as a primary diagnostic tool. *Ultrasound* - **Transvaginal ultrasound (TVS)** can identify endometriomas (chocolate cysts) and deep infiltrating endometriosis, but it cannot reliably visualize small peritoneal implants. - While it's a good initial imaging modality, its sensitivity for diagnosing all forms of endometriosis is **limited**. *MRI* - **MRI** offers better soft tissue contrast than ultrasound and can identify deep infiltrating endometriosis and some peritoneal implants, especially those involving the bowel or bladder. - However, MRI is **more expensive** and less accessible, and it still cannot definitively rule out all small, superficial endometrial lesions without direct visualization.

Q: In a severely anaemic pregnant patient presenting with cardiac failure, what is the most appropriate choice of transfusion?

Exchange transfusion. ***Exchange transfusion*** - In **severe anaemia with cardiac failure**, exchange transfusion simultaneously **removes** and **replaces** blood volume, correcting anaemia without **net volume increase** that could worsen cardiac failure. - This procedure is the **safest option** as it avoids **fluid overload** while effectively improving **oxygen-carrying capacity** in cardiac-compromised pregnant patients. *Platelets* - **Platelets** are indicated for **thrombocytopenia** or **platelet dysfunction** to prevent bleeding, not for correcting anaemia. - They provide no benefit for **oxygen transport** or the underlying cause of cardiac failure in this anaemic patient. *Packed cells* - **Packed red blood cells** still add **net volume** to circulation, which can precipitate **pulmonary edema** and worsen cardiac failure despite slower infusion. - Even with **diuretics**, the risk of **fluid overload** remains significant in patients with pre-existing cardiac compromise. *Whole blood* - **Whole blood** contains **plasma volume** that significantly increases circulatory load, making it particularly dangerous in cardiac failure. - The large **volume expansion** can rapidly lead to **congestive heart failure** and **pulmonary edema** in already compromised patients.

Question 1

Palmer sign is related to ?

Accepted Answer

Uterine contractions palpable through rectum during labor

Answer

Increased pulsations in uterine arteries

Answer

Bluish discoloration of cervix and vagina

Answer

Softening of the cervix during pregnancy

Question 2

What is the stage of endometrial carcinoma when it involves the cervix?

Accepted Answer

Stage 2: Cancer has spread to the cervix.

Answer

Stage 1: Cancer confined to the uterus.

Answer

Stage 3: Cancer has spread beyond the uterus but not beyond the pelvis.

Answer

Stage 4: Cancer has spread to distant sites.

Question 3

What is the treatment of choice for Bartholin's cyst?

Accepted Answer

Marsupialization

Answer

Excision

Answer

Antibiotic therapy

Answer

Cyst drainage

Question 4

Tdap vaccine is given in between which weeks of pregnancy?

Accepted Answer

27-36 weeks

Answer

10-16 weeks

Answer

17-22 weeks

Answer

22-26 weeks

Question 5

What is the most common complication that can arise from vacuum delivery during childbirth?

Accepted Answer

Cephalohematoma

Answer

Subgaleal hemorrhage

Answer

Scalp lacerations

Answer

Retinal hemorrhages

Question 6

All are causes of anovulatory amenorrhea except which of the following?

Accepted Answer

Gonadal dysgenesis

Answer

Hyperprolactinemia

Answer

Drugs

Answer

PCOD

Question 7

Which structure is least likely to be injured during common gynecological procedures?

Accepted Answer

Renal pelvis

Answer

Ureter at pelvic brim

Answer

Urinary bladder

Answer

Ureter at infundibulopelvic ligament

Question 8

Which of the following statements about tuberculosis (TB) of the uterus is NOT true?

Accepted Answer

Most common is ascending infection

Answer

Increase incidence of ectopic pregnancy

Answer

Involvement of endosalpinx

Answer

Mostly secondary

Question 9

Gold standard technique for diagnosis of endometriosis?

Accepted Answer

Laparoscopy

Answer

Ca 125 level

Answer

Ultrasound

Answer

MRI

Question 10

In a severely anaemic pregnant patient presenting with cardiac failure, what is the most appropriate choice of transfusion?

Accepted Answer

Exchange transfusion

Answer

Platelets

Answer

Packed cells

Answer

Whole blood

NEET-PG 2012 — Obstetrics and Gynecology