NEET-PG 2012 - Obstetrics and Gynecology Practice Questions

Q: What is the most common primary malignancy of the fallopian tube?

Serous carcinoma. ***Serous carcinoma*** - **Serous carcinoma** is the most common type of **primary** fallopian tube malignancy, accounting for approximately **90%** of primary tumors. - It often shares molecular and morphological similarities with **high-grade serous ovarian carcinoma** and **primary peritoneal cancer**. - Note: While primary fallopian tube cancer is rare (0.14-1.8% of gynecologic malignancies), metastatic disease to the fallopian tube is more common, typically from **ovarian or endometrial** primaries. *Squamous cell carcinoma* - **Squamous cell carcinoma** is exceedingly rare in the fallopian tube, as the tubal lining is composed of **ciliated and secretory columnar epithelium**, not squamous epithelium. - When present, it usually represents **metastatic spread** from cervical or other primary sites. *Teratoma* - **Teratomas** are germ cell tumors typically found in the **ovaries**, composed of tissues from multiple germ layers. - Primary teratomas of the fallopian tube are **extraordinarily rare** and not the most common primary malignancy. *Choriocarcinoma* - **Choriocarcinoma** is a highly malignant **gestational trophoblastic neoplasm** usually associated with pregnancy complications. - It primarily occurs in the **uterus**, and primary fallopian tube choriocarcinoma is **exceptionally uncommon**.

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

Intrauterine Contraceptive Device (IUCD). ***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.

Q: Decidual reaction is due to which hormone?

Progesterone. ***Progesterone*** - The **decidual reaction** is a specific uterine stromal cell differentiation process that prepares the endometrium for **implantation and pregnancy maintenance**. - This process is primarily induced and maintained by **progesterone**, which causes stromal cells to enlarge, accumulate glycogen and lipids, and secrete various factors essential for embryonic development. *Estrogen* - Estrogen plays a crucial role in the **proliferation of the endometrium** during the follicular phase, building up the uterine lining. - While estrogen is essential, it acts in conjunction with progesterone; progesterone is the **primary hormone** responsible for the decidualization process itself. *LH* - Luteinizing hormone (LH) is responsible for triggering **ovulation** and stimulating the corpus luteum to produce progesterone. - LH's direct role is not in the decidual reaction of the endometrium but rather in the **ovarian events** that lead to the production of the hormones that cause decidualization. *FSH* - Follicle-stimulating hormone (FSH) is vital for the growth and maturation of **ovarian follicles** and **estrogen production**. - FSH does not directly induce the decidual reaction but facilitates the production of estrogen, which then contributes to endometrial proliferation, a precursor to progesterone's decidualizing effect.

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 treatment for uterine prolapse in nulliparous women?

Manchester operation. ***Manchester operation*** - This procedure is sometimes considered for **nulliparous women** with uterine prolapse, particularly if combined with cervical elongation. - It involves **amputation of the cervix** and support of the cardinal ligaments, which can address the prolapse while preserving uterine function. *Sling used involving rectus sheath* - A sling using the rectus sheath is typically employed for **stress urinary incontinence**, not primarily for uterine prolapse. - While it supports the urethra and bladder neck, it does not directly address the descent of the uterus. *Anterior colporrhaphy* - This procedure repairs a **cystocele** (prolapse of the bladder into the vagina) by tightening the anterior vaginal wall. - It does not directly manage **uterine prolapse** itself, though a cystocele can coexist with uterine descent. *Posterior colporrhaphy* - This surgical repair targets a **rectocele** (prolapse of the rectum into the vagina) by tightening the posterior vaginal wall. - Similar to anterior colporrhaphy, it addresses a specific vaginal wall defect rather than the **uterine position**.

Q: Which of the following is a recognized method for the delivery of the after-coming head of a breech?

Mauriceau-Smellie-Veit maneuver. ***Mauriceau-Smellie-Veit maneuver*** - The **Mauriceau-Smellie-Veit maneuver** is the **gold standard** and most widely recognized method for delivering the after-coming head in breech delivery. - The technique involves the accoucheur placing the **index and middle fingers over the maxilla** (malar eminence) to flex the fetal head, while the fetal body rests on the forearm. - An assistant applies **suprapubic pressure** to maintain flexion of the fetal head. - This method provides excellent **control of the fetal head** and maintains proper flexion to prevent extension and facilitate safe delivery. *Burns and Marshall method* - The **Burns-Marshall method** is also a recognized technique for assisted breech delivery, but it is typically used when the body delivers spontaneously. - This method involves holding the fetal feet and allowing the baby to hang by its own weight, promoting flexion, then sweeping the baby upward over the maternal abdomen. - While valid, it is generally considered an **alternative** to the Mauriceau-Smellie-Veit maneuver rather than the primary method. *Forceps method* - **Piper forceps** are specifically designed for the after-coming head and are a recognized method, particularly when manual methods fail or in cases of **fetal distress**. - However, forceps application requires specific expertise and may not be the first-line approach in all settings. - When used appropriately, forceps provide controlled delivery and protect the fetal head. *Malar flexion and shoulder traction* - This is **not a recognized standard method** as described. - While malar pressure is used in the Mauriceau-Smellie-Veit maneuver, **shoulder traction** is dangerous and can cause **brachial plexus injury**, **Erb's palsy**, or **spinal cord damage**. - Traction should never be applied to the shoulders during breech delivery.

Q: Which of the following statements about cholestasis of pregnancy is false?

Most common cause of jaundice in pregnancy. ***Most common cause of jaundice in pregnancy*** - This statement is **FALSE** - while **intrahepatic cholestasis of pregnancy (ICP)** is the most common **pregnancy-specific** cause of jaundice, it is NOT the most common cause of jaundice overall in pregnancy. - **Viral hepatitis** (especially hepatitis A, B, and E) remains the **most common cause of jaundice in pregnancy** worldwide, accounting for approximately 40-50% of cases. - ICP accounts for about 20-25% of jaundice cases in pregnancy, making it the leading obstetric-specific cause but not the overall leading cause. *Bilirubin level >2mg%* - In ICP, **bilirubin levels** are typically **normal or only mildly elevated** (usually 10 μmol/L), not bilirubin. *Oestrogen is involved* - **TRUE** - Elevated **estrogen and progesterone levels** during pregnancy play a key role in ICP pathophysiology. - These hormones affect **hepatic bile salt transporters** (particularly BSEP and MDR3), leading to impaired bile secretion in genetically susceptible individuals. *Manifestations usually appear in last trimester* - **TRUE** - ICP typically presents in the **third trimester** (usually after 28 weeks), with **pruritus** as the predominant symptom. - Symptoms resolve within days to weeks after delivery, correlating with declining hormone levels.

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 which scenario is the I-pill (emergency contraceptive) most appropriately used?

In case of contraceptive failure or unprotected sex. ***In case of contraceptive failure or unprotected sex*** - This is the **most comprehensive and appropriate answer** as it covers **both major indications** for emergency contraception. - The **I-pill (levonorgestrel)** is indicated when there has been unprotected intercourse OR when a contraceptive method has failed (e.g., condom breakage, missed pills, dislodged IUD). - It should be taken as soon as possible, ideally within **72 hours** of the event, though it can be used up to 120 hours with reduced efficacy. - This option correctly encompasses the full scope of emergency contraception use. *After unprotected sexual intercourse* - While this is a **valid indication**, it only covers one scenario and is not as comprehensive as the correct answer. - This option misses situations of contraceptive failure where intercourse was technically "protected" but the method failed. *When a contraceptive method fails* - This is also a **valid indication** but only covers contraceptive accidents (condom breakage, missed pills). - It excludes situations where no contraceptive was used at all. - Like the previous option, it is incomplete compared to the correct answer. *As a regular contraceptive method* - The I-pill is **not intended for routine contraception** due to higher hormone doses and lower efficacy compared to regular methods. - It has a higher side effect profile with frequent use and does not protect against sexually transmitted infections. - Emergency contraception should only be used occasionally in emergency situations.

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.

Question 1

What is the most common primary malignancy of the fallopian tube?

Accepted Answer

Serous carcinoma

Answer

Squamous cell carcinoma

Answer

Teratoma

Answer

Choriocarcinoma

Question 2

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

Accepted Answer

Intrauterine Contraceptive Device (IUCD)

Answer

Diaphragm

Answer

Condom

Answer

Oral Contraceptive Pills (OCP)

Question 3

Decidual reaction is due to which hormone?

Accepted Answer

Progesterone

Answer

Estrogen

Answer

LH

Answer

FSH

Question 4

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 5

What is the treatment for uterine prolapse in nulliparous women?

Accepted Answer

Manchester operation

Answer

Anterior colporrhaphy

Answer

Posterior colporrhaphy

Answer

Sling used involving rectus sheath

Question 6

Which of the following is a recognized method for the delivery of the after-coming head of a breech?

Accepted Answer

Mauriceau-Smellie-Veit maneuver

Answer

Burns and Marshall method

Answer

Malar flexion and shoulder traction

Answer

Forceps method

Question 7

Which of the following statements about cholestasis of pregnancy is false?

Accepted Answer

Most common cause of jaundice in pregnancy

Answer

Bilirubin level >2mg%

Answer

Oestrogen is involved

Answer

Manifestations usually appear in last trimester

Question 8

Gold standard technique for diagnosis of endometriosis?

Accepted Answer

Laparoscopy

Answer

Ca 125 level

Answer

Ultrasound

Answer

MRI

Question 9

In which scenario is the I-pill (emergency contraceptive) most appropriately used?

Accepted Answer

In case of contraceptive failure or unprotected sex

Answer

When a contraceptive method fails

Answer

After unprotected sexual intercourse

Answer

As a regular contraceptive method

Question 10

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

Accepted Answer

Marsupialization

Answer

Excision

Answer

Antibiotic therapy

Answer

Cyst drainage

NEET-PG 2012 — Obstetrics and Gynecology