NEET-PG 2012 - Obstetrics and Gynecology Practice Questions

Q: What is the definitive management for adenomyosis?

Hysterectomy (surgical removal of the uterus).. ***Hysterectomy (surgical removal of the uterus)*** - This is considered the **definitive management** for adenomyosis because it completely removes the uterine tissue where the ectopic endometrial glands are found. - Hysterectomy effectively eliminates the source of symptoms such as **heavy menstrual bleeding** and **pelvic pain** by removing the uterus entirely. *Endometrial ablation* - Endometrial ablation involves destroying the **lining of the uterus** and is primarily used for heavy menstrual bleeding. - It is **ineffective for adenomyosis** since the endometrial tissue is embedded deep within the myometrium and is not fully reached by ablation. *Hormonal therapy (e.g., Danazol) for temporary symptom relief* - **Danazol** (an androgen derivative) can suppress ovarian function and reduce symptoms of adenomyosis by shrinking endometrial tissue. - However, its effects are **temporary**, and symptoms typically return upon cessation of treatment, making it not a definitive solution. *Hormonal therapy (e.g., GNRH analogue) for temporary symptom relief* - **GnRH analogues** induce a temporary menopausal state, which can significantly reduce symptoms by inhibiting estrogen production, leading to atrophy of the adenomyotic tissue. - This treatment is also **temporary**, and symptoms often recur once the medication is stopped; it's often used as a bridge to surgery or for women nearing menopause.

Q: What is the most reliable test to confirm ovulation after it has occurred?

Serum progesterone. ***Serum progesterone*** - A **serum progesterone level** of greater than **3 ng/mL (or 10 nmol/L)** in the mid-luteal phase (approximately 7 days after the presumed ovulation) reliably indicates that ovulation has occurred. - After ovulation, the **corpus luteum** forms and produces progesterone, causing a characteristic rise in its serum level. *Serum estrogen* - Estrogen levels **peak before ovulation** to trigger the LH surge and also rise during the luteal phase, but a single measurement is not a reliable indicator that ovulation has successfully occurred. - Estrogen levels can fluctuate due to various factors and do not directly confirm the **formation and function of a corpus luteum** as progesterone does. *Both serum estrogen and progesterone* - While both hormones are involved in the menstrual cycle, relying on both simultaneously for confirming *occurred* ovulation is not the most precise method. - A significant rise in **progesterone** *after* the presumed ovulatory event is the key reliable biomarker. *None of the options* - This option is incorrect because **serum progesterone** is a well-established and reliable test for confirming ovulation.

Q: Which condition is associated with exclusively fetal blood loss?

Vasa previa. ***Vasa previa*** - Vasa previa occurs when **fetal blood vessels** from the umbilical cord traverse the membranes over the cervical os, underneath the fetal presenting part. - Rupture of these unprotected vessels, which can happen during labor or membrane rupture, leads to **exclusively fetal blood loss**, posing a high risk of fetal exsanguination and death. *Placenta praevia* - This condition involves the **placenta implanting low** in the uterus, potentially covering the internal cervical os. - Bleeding in placenta previa is typically **maternal** in origin, resulting from the detachment of the placenta from the uterine wall as the cervix dilates. *Polyhydramnios* - Polyhydramnios is characterized by an **excessive amount of amniotic fluid**. - It is not directly associated with antepartum or intrapartum bleeding, but rather with conditions that affect fetal swallowing or urination, such as **fetal gastrointestinal anomalies** or maternal diabetes. *Oligohydramnios* - Oligohydramnios refers to an **insufficient amount of amniotic fluid**. - While it can be associated with various fetal and maternal complications, such as **renal agenesis** or premature rupture of membranes, it does not typically cause blood loss.

Q: What is the best method to diagnose an unruptured ectopic pregnancy?

USG. ***Correct Answer: USG*** - **Transvaginal ultrasound (TVS)** is the most common and effective method for diagnosing an unruptured ectopic pregnancy. It allows for visualization of a gestational sac outside the uterus or an adnexal mass. - In conjunction with **serum beta-hCG levels**, TVS helps to differentiate between an intrauterine pregnancy and an ectopic pregnancy, especially when hCG levels are above the discriminatory zone (typically 1500-2000 mIU/mL). - TVS has high sensitivity and specificity for detecting ectopic pregnancy and is **non-invasive**. *Incorrect: Endoscopy* - **Endoscopy** (such as laparoscopy) is a surgical procedure, primarily used for direct visualization and treatment of ectopic pregnancies, not for initial diagnosis. - It is *too invasive* for routine diagnostic purposes in an unruptured ectopic pregnancy. *Incorrect: UPT* - A **urine pregnancy test (UPT)** confirms pregnancy but *cannot determine the location* of the pregnancy. - A positive UPT only indicates the presence of **hCG**, which is elevated in both intrauterine and ectopic pregnancies. *Incorrect: Culdocentesis* - **Culdocentesis** involves aspirating fluid from the cul-de-sac and is used to detect the presence of *free blood* in the peritoneal cavity, indicating a **ruptured** ectopic pregnancy. - It is not useful for diagnosing an **unruptured ectopic pregnancy** and is largely replaced by ultrasound in modern practice.

Q: In pregnancy, plasma volume increase is maximum at what gestational age?

30 wks. ***30 wks*** - **Plasma volume** typically reaches its maximum expansion around **30-34 weeks of gestation**, increasing by approximately 40-50% compared to pre-pregnancy levels. - This increase is crucial for supporting the **fetoplacental unit**, enhancing nutrient delivery, and protecting against supine hypotension. *10 wks* - At **10 weeks**, the increase in plasma volume is still modest, with significant expansion primarily occurring in the **second trimester**. - Most of the rapid expansion begins after the **first trimester**, around the 12-week mark. *20 wks* - While plasma volume is significantly increasing by **20 weeks**, it has not yet reached its peak. - The continuous expansion continues through the **third trimester** before stabilizing. *25 wks* - At **25 weeks**, plasma volume is substantially elevated, but the maximum expansion is usually observed a few weeks later. - The peak is generally in the **early third trimester**, around 30-34 weeks.

Q: A 35 year old female with history of repeated D&C now has secondary amenorrhea. What is your diagnosis?

Asherman's syndrome. ***Asherman's syndrome*** - This syndrome is characterized by the formation of **intrauterine adhesions** or scar tissue following uterine trauma, often from repeated **Dilation and Curettage (D&C)** procedures. - The adhesions can prevent the normal growth and shedding of the **endometrial lining**, leading to **secondary amenorrhea** and infertility. *Hypothyroidism* - While hypothyroidism can cause menstrual irregularities, including **amenorrhea**, it would not typically be linked to a history of **repeated D&C procedures**. - The mechanism involves **hormonal imbalances** (e.g., elevated **TRH leading to elevated prolactin**), not scarring of the uterus. *Kallman syndrome* - This is a rare genetic condition causing **hypogonadotropic hypogonadism** and **anosmia** (loss of smell), leading to **primary amenorrhea**. - It does not involve uterine scarring and is not associated with D&C procedures or **secondary amenorrhea**. *Sheehan's syndrome* - Sheehan's syndrome is **postpartum hypopituitarism** caused by **ischemic necrosis of the pituitary gland** after severe hemorrhage during or after childbirth. - It would present with symptoms like **lactation failure** and could cause **secondary amenorrhea**, but it is not related to repeated D&C procedures.

Q: What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?

7 weeks. ***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.

Q: What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?

Contracted pelvis. ***Contracted pelvis*** - A **contracted pelvis** means the maternal pelvic dimensions are too small to allow for the safe passage of the fetus, making a vaginal birth impossible or highly risky. - This **fetopelvic disproportion** (cephalopelvic disproportion) necessitates a C-section to prevent obstructed labor, fetal distress, and potential harm to both mother and baby. - A contracted pelvis is a **definitive indication** for LSCS as vaginal delivery is contraindicated. *Mento anterior presentation* - In a **mento anterior presentation**, the fetal chin (mentum) is anterior, which is a **favorable position** for vaginal delivery as it allows for proper neck extension and engagement. - This presentation does not typically require a C-section unless there are other complicating factors. *Occipito posterior presentation* - While an **occipito posterior presentation** can sometimes lead to prolonged labor or the need for instrumental delivery, it is **not an absolute indication** for C-section. - Many cases can still deliver vaginally, either spontaneously or with rotation, and surgical intervention is usually reserved for failure to progress or fetal distress. *Vertex presentation* - A **vertex presentation** means the fetal head is flexed and presenting first, which is the **most common and ideal presentation** for a vaginal birth. - This presentation is a sign of a normal, potentially uncomplicated delivery and is the opposite of an indication for C-section.

Q: Spinnbarkeit is maximum shown at which phase?

Ovulatory. ***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.

Q: At which stage of cervical cancer is hydronephrosis typically observed?

Stage 3B. ***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 1

What is the definitive management for adenomyosis?

Accepted Answer

Hysterectomy (surgical removal of the uterus).

Answer

Endometrial ablation.

Answer

Hormonal therapy (e.g., Danazol) for temporary symptom relief.

Answer

Hormonal therapy (e.g., GnRH analogue) for temporary symptom relief.

Question 2

What is the most reliable test to confirm ovulation after it has occurred?

Accepted Answer

Serum progesterone

Answer

Serum estrogen

Answer

Both serum estrogen and progesterone

Answer

None of the options

Question 3

Which condition is associated with exclusively fetal blood loss?

Accepted Answer

Vasa previa

Answer

Placenta praevia

Answer

Polyhydramnios

Answer

Oligohydramnios

Question 4

What is the best method to diagnose an unruptured ectopic pregnancy?

Accepted Answer

USG

Answer

Endoscopy

Answer

UPT

Answer

Culdocentesis

Question 5

In pregnancy, plasma volume increase is maximum at what gestational age?

Accepted Answer

30 wks

Answer

10 wks

Answer

20 wks

Answer

25 wks

Question 6

A 35 year old female with history of repeated D&C now has secondary amenorrhea. What is your diagnosis?

Accepted Answer

Asherman's syndrome

Answer

Hypothyroidism

Answer

Kallman syndrome

Answer

Sheehan's syndrome

Question 7

What is the maximum gestational age (from LMP) for performing medical termination of early pregnancy using mifepristone and misoprostol?

Accepted Answer

7 weeks

Answer

21 days

Answer

4 weeks

Answer

14 days

Question 8

What is a definitive indication for performing a Lower Segment Cesarean Section (LSCS)?

Accepted Answer

Contracted pelvis

Answer

Mento anterior presentation

Answer

Occipito posterior presentation

Answer

Vertex presentation

Question 9

Spinnbarkeit is maximum shown at which phase?

Accepted Answer

Ovulatory

Answer

Menstrual phase

Answer

Post ovulatory

Answer

Follicular phase

Question 10

At which stage of cervical cancer is hydronephrosis typically observed?

Accepted Answer

Stage 3B

Answer

Stage 2A

Answer

Stage 2B

Answer

Stage 3A

NEET-PG 2012 — Obstetrics and Gynecology