At which stage of cervical cancer is hydronephrosis typically observed?
What is the stage of endometrial carcinoma when it involves the cervix?
Which of the following pelvic measurements is most commonly used in clinical practice?
Which virus has the highest chance of transmission to the newborn during delivery?
After delivery upto which week is known as puerperium?
What is the most common complication that can arise from vacuum delivery during childbirth?
35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?
What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?
Spinnbarkeit is maximum shown at which phase?
What is the most common cause of hydrops fetalis in current medical practice?
NEET-PG 2012 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 41: At which stage of cervical cancer is hydronephrosis typically observed?
- A. Stage 2A
- B. Stage 2B
- C. Stage 3A
- D. Stage 3B (Correct Answer)
Explanation: ***Stage 3B*** - **Hydronephrosis** in cervical cancer is typically a sign of advanced disease where the tumor has spread to the **pelvic side wall**, compressing the **ureters**. - According to the **FIGO staging system**, involvement of the **pelvic side wall** and/or causing **hydronephrosis** indicates **Stage IIIB** disease. *Stage 2A* - This stage involves invasion beyond the uterus but **without involvement of the lower third of the vagina or parametrium**. - **Hydronephrosis** would not be expected at this earlier stage as it typically signifies more extensive tumor bulk or spread. *Stage 2B* - This stage indicates involvement of the **parametrium** but **without extension to the pelvic side wall**. - While the tumor is more advanced than Stage 2A, it is not yet associated with the direct **ureteral compression** that leads to **hydronephrosis**. *Stage 3A* - This stage involves the **lower third of the vagina** but **not the pelvic side wall**. - Although the tumor has spread to the vagina, the specific characteristic of **hydronephrosis** due to **ureteral obstruction** by the tumor reaching the pelvic side wall differentiating Stage 3A from Stage 3B is not present.
Question 42: What is the stage of endometrial carcinoma when it involves the cervix?
- A. Stage 1: Cancer confined to the uterus.
- B. Stage 3: Cancer has spread beyond the uterus but not beyond the pelvis.
- C. Stage 2: Cancer has spread to the cervix. (Correct Answer)
- D. Stage 4: Cancer has spread to distant sites.
Explanation: ***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.
Question 43: Which of the following pelvic measurements is most commonly used in clinical practice?
- A. Diagonal conjugate (Correct Answer)
- B. Transverse diameter of outlet
- C. Oblique diameter of pelvis
- D. Anteroposterior diameter of inlet
Explanation: ***Diagonal conjugate*** - This measurement is the most commonly used in clinical practice due to its **accessibility** and ability to estimate the **obstetrical conjugate**, which indicates the true AP diameter of the pelvic inlet. - It is measured vaginally from the **lower border of the symphysis pubis** to the **sacral promontory**. *Anteroposterior diameter of inlet* - This measurement, also known as the **obstetrical conjugate**, truly represents the narrowest AP diameter for fetal passage through the inlet. - However, it cannot be measured directly clinically and must be estimated from the diagonal conjugate or imaging. *Transverse diameter of outlet* - This measurement is important for assessing the **midpelvis** and **pelvic outlet**, but it is less commonly the primary measurement used for initial pelvic assessment compared to the diagonal conjugate. - A compromised transverse diameter can indicate a generally contracted pelvis or **android/anthropoid pelvic shapes**, which may lead to obstructed labor. *Oblique diameter of pelvis* - The oblique diameter provides information about the **symmetry of the pelvis**, but it is not routinely measured clinically unless there is suspicion of pelvic asymmetry or disease. - Significant asymmetry, often due to injury or disease (e.g., **scoliosis**, polio), can complicate labor by misdirecting the fetal head.
Question 44: Which virus has the highest chance of transmission to the newborn during delivery?
- A. HSV (Correct Answer)
- B. CMV
- C. VZV
- D. Rubella
Explanation: ***HSV*** - **Herpes Simplex Virus (HSV)** has the **highest transmission rate during vaginal delivery** if the mother has active genital lesions, with transmission rates of **30-50% for recurrent infection** and up to **85-90% for primary infection**. - Neonatal herpes can lead to severe disseminated disease, central nervous system involvement, or mucocutaneous lesions with high morbidity and mortality. - **Cesarean section is indicated** if active lesions are present at the time of labor to prevent transmission. *CMV* - **Cytomegalovirus (CMV)** is primarily transmitted **congenitally (in utero)** rather than during delivery. - While perinatal transmission can occur through cervical secretions or blood during delivery, the rate is **much lower** than HSV and most postnatal transmission occurs through **breastfeeding**. - Intrapartum transmission, when it occurs, generally causes less severe disease compared to congenital infection. *VZV* - **Varicella-Zoster Virus (VZV)** transmission to the newborn occurs primarily when maternal infection develops **within 5 days before to 2 days after delivery**. - This can cause severe neonatal varicella, but the **overall intrapartum transmission rate is lower** than HSV. - Most severe fetal effects occur with **congenital varicella syndrome** (first or second trimester infection). *Rubella* - **Rubella** is almost exclusively transmitted **congenitally during early pregnancy**, leading to **congenital rubella syndrome**. - There is **no significant transmission during delivery** itself. - The critical period for fetal damage is during the first trimester, not at the time of birth.
Question 45: After delivery upto which week is known as puerperium?
- A. 2 weeks
- B. 4 weeks
- C. 6 weeks (Correct Answer)
- D. 8 weeks
Explanation: ***6 weeks*** - The **puerperium** is the period of approximately **6 weeks** after childbirth during which the mother's body undergoes physiological adaptations to return to its non-pregnant state. - This timeframe allows for the involution of the uterus and the restoration of reproductive organs and systemic physiology. *2 weeks* - This period is too short to encompass the full physiological recovery process after childbirth. - While immediate postpartum changes occur, many maternal systems, such as the reproductive organs, have not fully reverted to their pre-pregnancy state within 2 weeks. *4 weeks* - This duration is still considered an incomplete period for the extensive physiological changes that define the puerperium. - Uterine involution often continues beyond 4 weeks, and other hormonal and systemic adjustments are still ongoing. *8 weeks* - While recovery continues, the primary definition of the puerperium typically concludes at **6 weeks postpartum**. - By 8 weeks, most significant physiological changes have already occurred, and the body is largely back to its pre-pregnant state.
Question 46: What is the most common complication that can arise from vacuum delivery during childbirth?
- A. Subgaleal hemorrhage
- B. Scalp lacerations
- C. Cephalohematoma (Correct Answer)
- D. Retinal hemorrhages
Explanation: ***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.
Question 47: 35 yr old with 4 months amenorrhea with increased FSH, decreased estrogen. What is the diagnosis?
- A. Premature ovarian failure (Correct Answer)
- B. Pituitary dysfunction
- C. Hypothalamic dysfunction
- D. Polycystic Ovary Syndrome
Explanation: ***Premature ovarian failure*** - The combination of **amenorrhea** for 4 months in a 35-year-old, with **increased FSH** and **decreased estrogen**, is characteristic of premature ovarian failure, indicating the ovaries are no longer responding to FSH stimulation. - This condition signifies the cessation of ovarian function before the age of 40, leading to menopausal symptoms and infertility. *Pituitary dysfunction* - Pituitary dysfunction might lead to **decreased FSH** (hypogonadotropic hypogonadism) due to insufficient stimulation of the ovaries, not increased FSH. - In cases of pituitary adenomas, increased prolactin can cause amenorrhea, but FSH would not be elevated in the manner described. *Hypothalamic dysfunction* - Hypothalamic dysfunction, such as **functional hypothalamic amenorrhea**, typically presents with **low or normal FSH and LH levels** (hypogonadotropic hypogonadism) due to reduced GnRH pulsatility. - This condition is often associated with stress, excessive exercise, or low body weight, and would not cause elevated FSH as seen here. *Polycystic Ovary Syndrome* - **Polycystic Ovary Syndrome (PCOS)** is characterized by **anovulation**, resulting in amenorrhea or oligomenorrhea, but typically involves **elevated androgens** and a **high LH-to-FSH ratio**, with FSH levels generally normal or low, and estrogen levels often normal or slightly elevated. - It would not present with simultaneously high FSH and low estrogen, which points to ovarian failure rather than anovulation with intact ovarian reserve.
Question 48: What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?
- A. 7 weeks (Correct Answer)
- B. 21 days
- C. 4 weeks
- D. 14 days
Explanation: ***7 weeks (49 days)*** - Medical termination of pregnancy using **mifepristone and misoprostol** is most effective up to **49 days (7 weeks) of gestation** from the first day of the last menstrual period (LMP). - This is the **FDA-approved and WHO-recommended timeframe** for medical abortion with optimal efficacy (95-98% success rate). - The **MTP Act in India** allows medical methods up to **63 days (9 weeks)**, but 49 days represents the timeframe with highest efficacy and lowest complication rates. - Beyond this period, success rates decline and surgical methods may be more appropriate. *21 days* - This is only **3 weeks of gestation**, far too early and restrictive for medical abortion guidelines. - Most women wouldn't have confirmed pregnancy by this time. - This is not aligned with any standard medical abortion protocol. *4 weeks* - At **4 weeks gestation**, pregnancy has just been missed (around time of expected period). - This is too restrictive and not the maximum allowable timeframe for medical abortion. - Medical abortion can safely be performed well beyond this point. *14 days* - This is only **2 weeks of gestation** (around the time of ovulation in a typical cycle). - Pregnancy cannot even be reliably detected at this point. - This timeframe has no relevance to medical abortion guidelines.
Question 49: Spinnbarkeit is maximum shown at which phase?
- A. Menstrual phase
- B. Ovulatory (Correct Answer)
- C. Post ovulatory
- D. Follicular phase
Explanation: ***Ovulatory*** - **Spinnbarkeit** refers to the stringy, stretchy quality of cervical mucus, which is maximal during the ovulatory phase due to high **estrogen levels**. - This highly elastic mucus facilitates **sperm transport** to the uterus and fallopian tubes for fertilization. *Menstrual phase* - During the menstrual phase, **cervical mucus** is typically minimal and sticky, making it unfavorable for sperm survival. - This phase is characterized by low estrogen and progesterone levels, leading to the **shedding of the uterine lining**. *Post ovulatory* - After ovulation, under the influence of **progesterone**, cervical mucus becomes thick, sticky, and opaque, decreasing **spinnbarkeit**. - This change in mucus consistency forms a **barrier to sperm penetration** into the uterus. *Follicular phase* - In the early follicular phase, **estrogen levels** are low, resulting in thick, scanty, and opaque cervical mucus with low **spinnbarkeit**. - As the follicular phase progresses and estrogen levels rise, the mucus gradually becomes more **watery and elastic**, but it doesn't reach its peak stretchiness until ovulation.
Question 50: What is the most common cause of hydrops fetalis in current medical practice?
- A. Fetal infections (e.g., parvovirus B19)
- B. Chromosomal abnormalities
- C. Cardiac malformations (Correct Answer)
- D. Rh incompatibility (historically significant)
Explanation: ***Cardiac malformations*** - **Cardiovascular abnormalities** are the **most common cause** of **non-immune hydrops fetalis** in current medical practice, accounting for **20-40%** of cases - Includes **structural heart defects** (septal defects, valvular abnormalities) and **arrhythmias** (supraventricular tachycardia, complete heart block) - These conditions lead to **heart failure** and **increased hydrostatic pressure**, causing fluid accumulation in fetal tissues and body cavities - With the near-elimination of Rh disease through immunoprophylaxis, cardiac causes have emerged as the leading etiology *Chromosomal abnormalities* - Account for **10-20%** of non-immune hydrops cases - **Turner syndrome (45,X)** is the most common chromosomal cause, associated with **cystic hygroma** and **lymphatic dysgenesis** - Other chromosomal conditions include **trisomy 21, 18, and 13**, which can cause hydrops through associated cardiac defects or other mechanisms - While significant, chromosomal causes are less common than cardiovascular causes overall *Fetal infections (e.g., parvovirus B19)* - Infections account for **5-10%** of non-immune hydrops cases - **Parvovirus B19** is the most common infectious cause, leading to severe **fetal anemia** through bone marrow suppression - Other infectious agents include **CMV**, **toxoplasmosis**, and **syphilis** - The TORCH screening helps identify treatable infectious causes *Rh incompatibility (historically significant)* - Historically the **leading cause** before the 1970s, accounting for most hydrops cases - Now accounts for **<10%** of cases due to routine **Rho(D) immune globulin (RhoGAM)** administration at 28 weeks and postpartum - Causes **immune hydrops** through maternal antibodies crossing the placenta and destroying fetal red blood cells, leading to severe anemia and heart failure - Still important in under-immunized populations or cases of missed prophylaxis