NEET-PG 2013 - Obstetrics and Gynecology Practice Questions

Q: Which of the following is a method of natural family planning that involves tracking basal body temperature?

Basal body temperature (BBT) method. ***Basal body temperature (BBT) method*** - The **basal body temperature** (BBT) method relies on a slight increase in a woman's resting body temperature, typically by 0.5 to 1.0°F, occurring after **ovulation**. - This temperature shift signals that ovulation has occurred, allowing couples to identify the **fertile window** and avoid intercourse during that time. - This method involves tracking daily basal body temperature to predict ovulation. *Coitus interruptus (withdrawal method)* - This method involves the male withdrawing his penis from the vagina just before **ejaculation**. - It does not involve tracking **basal body temperature** and has a higher failure rate compared to many other contraceptive methods due to potential pre-ejaculatory fluid containing sperm. *Safe period (calendar method)* - The calendar method, also known as the **rhythm method** or **Ogino-Knaus method**, estimates the fertile window based on the typical length of a woman's menstrual cycles. - This method relies on calculating the approximate times of ovulation and avoiding intercourse during those days; it does not involve daily **temperature tracking**. *Abstinence (not having sexual intercourse)* - **Abstinence** involves completely refraining from sexual intercourse and is the only 100% effective method of preventing pregnancy and sexually transmitted infections (STIs). - This method does not involve any form of physical tracking, such as **basal body temperature**, as there is no risk of conception.

Q: Copper T is ideally inserted at-

Just after menstruation. ***Just after menstruation*** - The **endometrium is thin** immediately after menstruation, making insertion easier and reducing the risk of pain and perforation. - Inserting it after menstruation also helps to ensure the woman is **not pregnant** at the time of insertion, as the uterus has shed its lining. *Just before menstruation* - The endometrium is typically **thicker and more vascular** just before menstruation, increasing the risk of bleeding and pain during insertion. - There is a higher possibility of **early pregnancy**, which would contraindicate IUD insertion. *On the 26th day* - The 26th day of the menstrual cycle is usually in the **luteal phase**, when the endometrium is highly vascularized and receptive, which could increase discomfort and bleeding during insertion. - This timing also carries a **higher risk of pregnancy**, making IUD insertion potentially hazardous if not confirmed otherwise. *On the 14th day* - The 14th day typically corresponds to the **ovulation period**, making it a high-risk time for conception if protection has not been used. - The uterus is also more sensitive during ovulation, potentially leading to increased discomfort or complications during insertion.

Q: Which condition is responsible for approximately a quarter of postnatal maternal deaths?

Postpartum hemorrhage (PPH). ***Postpartum hemorrhage (PPH)*** - **Postpartum hemorrhage (PPH)** is the leading cause of maternal mortality worldwide, accounting for roughly a quarter of all postnatal maternal deaths. - PPH is defined as a blood loss of **500 mL or more** within 24 hours after vaginal birth, or **1000 mL or more** after a Cesarean section, and can lead to hypovolemic shock and death if not promptly managed. *Infection* - **Maternal infections**, such as puerperal sepsis, are a significant cause of maternal mortality but typically rank after PPH in overall incidence. - While infections contribute to postnatal deaths, they do not account for as high a proportion as PPH. *Eclampsia* - **Eclampsia** is a severe complication of pre-eclampsia, characterized by seizures, and is a major cause of maternal mortality and morbidity. - Though serious, its contribution to overall maternal deaths, while substantial, is less than that of PPH globally. *Anemia* - **Anemia** in the postpartum period can exacerbate other complications and increase the risk of maternal morbidity, but it is rarely a direct cause of maternal death on its own. - Severe anemia can lower the threshold for adverse outcomes from blood loss or infection but is not a primary cause of death at the same rate as PPH.

Q: Which of the following is classified as a third generation Intrauterine Contraceptive Device (IUCD)?

Mirena. ***Mirena*** - Mirena (levonorgestrel-releasing intrauterine system) is a **third-generation IUCD** that releases **progestin**, offering both contraceptive and therapeutic benefits. - Its mechanism of action involves **thickening cervical mucus**, thinning the uterine lining, and inhibiting sperm motility/viability. *Nova-T* - Nova-T is a **second-generation IUCD** that uses **copper** as its active contraceptive agent. - Copper IUCDs like Nova-T primarily work by causing a **sterile inflammatory reaction** in the uterus, making it spermicidal. *Lippe's loop* - Lippe's loop is a **first-generation IUCD** made of inert plastic, designed to **physically block** fertilization. - It is no longer widely used due to higher rates of expulsion and complications compared to newer generations. *CuT-200* - CuT-200 is a **second-generation IUCD** that releases **copper** to prevent pregnancy. - It works by producing a **local inflammatory response** in the uterus that is toxic to sperm and eggs.

Q: Which among the following is an absolute contraindication of Hormone replacement therapy?

Breast carcinoma. ### Breast carcinoma - Hormone replacement therapy (HRT) is **contraindicated** in breast carcinoma because many breast cancers are **estrogen-receptor positive**, meaning estrogen can stimulate their growth [1]. - Using HRT in patients with a history of breast cancer significantly increases the risk of **recurrence** or **progression** of the disease [1]. *Endometriosis* - Endometriosis is not an **absolute contraindication**; HRT can sometimes be used in women with a history of endometriosis, especially if a hysterectomy and bilateral oophorectomy have been performed. - However, unopposed estrogen therapy might **exacerbate** remaining endometrial implants, so a combined estrogen-progestin regimen is typically preferred [1]. *Heart disease* - While HRT has been shown to have **risks** in women with established coronary heart disease, it is not an absolute contraindication for all forms of heart disease. - The **Women's Health Initiative study** demonstrated increased cardiovascular events in older women initiating HRT, but current guidelines suggest that timing of initiation is crucial and benefits may outweigh risks for younger postmenopausal women. *Osteoarthritis* - Osteoarthritis is **not a contraindication** to HRT; in fact, some studies suggest that estrogen may have protective effects on cartilage [2]. - HRT is neither a treatment nor a contraindication for osteoarthritis and does not significantly impact its progression or severity [2].

Q: Which of the following methods is used for prenatal diagnosis of Down Syndrome?

Karyotyping for chromosomal analysis. ***Karyotyping for chromosomal analysis*** - **Karyotyping** is the gold standard definitive diagnostic method for Down syndrome (trisomy 21) as it directly visualizes and counts all chromosomes, identifying the presence of an extra copy of chromosome 21. - This cytogenetic method provides a clear genetic diagnosis with 100% accuracy, confirming the chromosomal abnormality responsible for Down syndrome. - Karyotyping can be performed on cells obtained via amniocentesis or chorionic villus sampling (CVS). *Triple test for biomarker screening* - The **triple test** measures biochemical markers (alpha-fetoprotein, unconjugated estriol, and hCG) to assess the risk of Down syndrome, but it is a **screening tool**, not a diagnostic method. - It has a detection rate of approximately 69% with a 5% false-positive rate. - Abnormal results require confirmatory diagnostic testing with karyotyping or other chromosomal analysis methods. *Fetal ultrasonography for physical feature assessment* - Fetal ultrasonography can detect **soft markers** such as increased nuchal translucency, absent/hypoplastic nasal bone, echogenic intracardiac focus, or structural anomalies that raise suspicion for Down syndrome. - However, ultrasound findings are **not diagnostic** on their own and have limited sensitivity and specificity. - Positive findings necessitate genetic testing like karyotyping for definitive diagnosis. *Non-invasive prenatal testing (NIPT) for cell-free DNA analysis* - **NIPT** analyzes cell-free fetal DNA in maternal blood and has high sensitivity (>99%) and specificity (>99%) for detecting trisomy 21. - Despite its excellent screening performance, NIPT is still classified as a **screening test**, not a diagnostic test. - Positive NIPT results require confirmation with diagnostic testing (karyotyping) before making clinical decisions regarding the pregnancy.

Q: Which of the following is the most common genital infection in pregnancy?

Vaginal candidiasis. ***Vaginal candidiasis*** - **Vaginal candidiasis**, commonly known as a yeast infection, is the **most frequent genital infection** during pregnancy due to hormonal changes that alter the vaginal microenvironment. - Pregnancy increases susceptibility through **elevated estrogen levels**, **increased vaginal glycogen**, and **altered vaginal pH**. - While generally not harmful to the fetus, it can cause significant maternal discomfort with symptoms like **itching**, burning, and a **thick, white, cottage cheese-like discharge**. *Gonorrhea* - Gonorrhea is a **sexually transmitted infection (STI)** that, although possible, is not the most common genital infection in pregnancy. - It carries a risk of serious complications for both mother and infant, including **preterm birth**, **chorioamnionitis**, and **neonatal conjunctivitis** (ophthalmia neonatorum). *Chlamydia* - Chlamydia is another **STI** that can occur during pregnancy but is not as common as candidiasis. - Untreated chlamydia can lead to **preterm rupture of membranes**, **preterm labor**, and **postpartum endometritis** in the mother, and **conjunctivitis** or **pneumonia** in the newborn. *Bacterial vaginosis* - Bacterial vaginosis (BV) is a common vaginal infection caused by an **imbalance in normal vaginal flora**, with overgrowth of anaerobic bacteria. - While BV is the most common vaginal infection in **non-pregnant women**, vaginal candidiasis is more frequently encountered during pregnancy due to hormonal changes. - BV in pregnancy is associated with increased risk of **preterm birth**, **preterm rupture of membranes**, and **postpartum endometritis**, making screening and treatment important.

Q: Which drug is associated with decreased fetal heart rate during labor?

Oxytocin. ***Oxytocin*** - **Oxytocin** stimulates uterine contractions, which can reduce blood flow to the placenta and temporarily decrease **fetal oxygenation**, leading to **fetal heart rate decelerations**. - Overstimulation of the uterus by oxytocin can result in **tachysystole** (>5 contractions in 10 minutes), potentially causing **fetal hypoxia** and associated changes in fetal heart rate patterns such as late decelerations or bradycardia. *Sodium bicarbonate* - **Sodium bicarbonate** is used to correct metabolic acidosis, but it does not directly affect **fetal heart rate** or uterine activity in a way that causes decelerations. - Its administration is unlikely to impact fetal heart rate unless the underlying condition causing acidosis also affects fetal well-being, which is not a direct drug effect. *IV fluids* - **Intravenous fluids** are often administered during labor to maintain hydration and support maternal circulation, which generally helps improve **fetal well-being** and maintain normal fetal heart rate patterns. - They can help optimize **uterine perfusion**, thereby improving oxygen delivery to the fetus and reducing the risk of fetal distress. *Iron* - **Iron** is essential for red blood cell production and preventing maternal anemia; it has no direct or acute effect on **fetal heart rate** during labor. - Administered as a supplement, iron is not a medication used during labor to impact **uterine contractility** or fetal heart rate in the way oxytocin does.

Q: What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?

200mg. ***200mg*** - The standard dose of **mifepristone** for medical termination of pregnancy (MTP) is **200mg orally**. - This dose is typically followed 24-48 hours later by a **prostaglandin analog** (e.g., misoprostol) to complete the termination process. *10mg* - This dose is significantly lower than the recommended therapeutic dose for medical abortion. - Such a low dose would likely be **ineffective** in achieving termination. *20 mg* - This dose is also much lower than the standard therapeutic recommendation. - It would not adequately block progesterone receptors to initiate the termination process effectively. *100mg* - While closer to the standard dose, 100mg is still considered **sub-therapeutic** for many individuals undergoing medical abortion. - A lower efficacy rate would be expected compared to the 200mg dose.

Question 1

Which of the following is a method of natural family planning that involves tracking basal body temperature?

Accepted Answer

Basal body temperature (BBT) method

Answer

Coitus interruptus (withdrawal method)

Answer

Safe period (calendar method)

Answer

Abstinence (not having sexual intercourse)

Question 2

Copper T is ideally inserted at-

Accepted Answer

Just after menstruation

Answer

Just before menstruation

Answer

On the 26th day

Answer

On the 14th day

Question 3

Which condition is responsible for approximately a quarter of postnatal maternal deaths?

Accepted Answer

Postpartum hemorrhage (PPH)

Answer

Eclampsia

Answer

Anemia

Answer

Infection

Question 4

Which of the following is classified as a third generation Intrauterine Contraceptive Device (IUCD)?

Accepted Answer

Mirena

Answer

Nova-T

Answer

Lippe's loop

Answer

CuT-200

Question 5

Which among the following is an absolute contraindication of Hormone replacement therapy?

Accepted Answer

Breast carcinoma

Answer

Endometriosis

Answer

Heart disease

Answer

Osteoarthritis

Question 6

Which of the following methods is used for prenatal diagnosis of Down Syndrome?

Accepted Answer

Karyotyping for chromosomal analysis

Answer

Non-invasive prenatal testing (NIPT) for cell-free DNA analysis

Answer

Triple test for biomarker screening

Answer

Fetal ultrasonography for physical feature assessment

Question 7

34 week primigravida punjabi khatri comes with history of consanguineous marriage, with history of repeated blood transfusion to her sibling since 8 months of age. The first diagnostic test is -

Accepted Answer

Hb electrophoresis

Answer

HPLC

Answer

Bone marrow

Answer

Blood smear

Question 8

Which of the following is the most common genital infection in pregnancy?

Accepted Answer

Vaginal candidiasis

Answer

Gonorrhea

Answer

Chlamydia

Answer

Bacterial vaginosis

Question 9

Which drug is associated with decreased fetal heart rate during labor?

Accepted Answer

Oxytocin

Answer

Sodium bicarbonate

Answer

IV fluids

Answer

Iron

Question 10

What is the standard dose of mifepristone in medical termination of pregnancy (MTP)?

Accepted Answer

200mg

Answer

10mg

Answer

20mg

Answer

100mg

NEET-PG 2013 — Obstetrics and Gynecology