Which type of pelvis is most commonly associated with dystocia?
In the context of obstructed labor, which maternal pelvic parameter is considered the most critical for successful delivery?
Which of the following symptoms is least commonly associated with endometriosis?
For routine diagnostic purposes, endometrial biopsy is usually done at which phase of the menstrual cycle?
Oligomenorrhoea means ?
What is Hegar's sign in obstetrics?
What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?
Commonest variety of compound presentation is?
What is the best parameter for estimating fetal age by ultrasound in the third trimester?
Ovarian reserve is best indicated by
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 21: Which type of pelvis is most commonly associated with dystocia?
- A. Android (Correct Answer)
- B. Platypelloid
- C. Gynaecoid
- D. Anthropoid
Explanation: ***Android*** - The **android pelvis** has a **heart-shaped inlet** and converging side walls, which significantly increases the risk of **dystocia** due to restricted passage for the fetal head. - This pelvic shape is more common in men but can also be found in women, leading to a higher likelihood of **cephalopelvic disproportion**. *Platypelloid* - The **platypelloid pelvis** has a **flattened oval inlet** with a short anteroposterior diameter and a wide transverse diameter. - While it can lead to difficulties with engagement and rotation, it is not as commonly associated with severe dystocia as the android type, as the fetal head can often rotate to fit. *Gynaecoid* - The **gynaecoid pelvis** is considered the **ideal female pelvis** with a rounded or slightly oval inlet and well-proportioned diameters. - It is associated with the **easiest and most successful vaginal deliveries** and therefore is least likely to cause dystocia. *Anthropoid* - The **anthropoid pelvis** has an **oval inlet** with a long anteroposterior diameter and a relatively short transverse diameter. - While it can sometimes lead to an **occiput-posterior presentation**, it is not as strongly associated with dystocia as the android pelvis.
Question 22: In the context of obstructed labor, which maternal pelvic parameter is considered the most critical for successful delivery?
- A. Biparietal diameter
- B. Bitemporal diameter
- C. Diameter of pelvic outlet
- D. Diameter of pelvic inlet (Correct Answer)
Explanation: ***Diameter of pelvic inlet*** - The **pelvic inlet** is typically the narrowest and most critical passage for the fetal head to engage and descend into the pelvis during labor. - An inadequate pelvic inlet diameter can lead to **cephalopelvic disproportion**, resulting in **obstructed labor** because the fetal head cannot enter the true pelvis. *Diameter of pelvic outlet* - While important for the final stages of labor, an inadequate **pelvic outlet** usually presents a problem only after the fetal head has successfully navigated the inlet and mid-pelvis. - Obstruction at the outlet is less common as the primary cause of prolonged or arrested first stage labor compared to an unyielding inlet. *Biparietal diameter* - The **biparietal diameter (BPD)** measures the widest transverse diameter of the fetal head, which is crucial but represents a fetal parameter. - While critical for assessing fetal head size in relation to the maternal pelvis, it is a fetal measurement, not a maternal pelvic parameter like the inlet. *Bitemporal diameter* - The **bitemporal diameter** is the shortest transverse diameter of the fetal head and is rarely the presenting issue in **obstructed labor**. - It is typically much smaller than the biparietal diameter and usually presents no obstacle to passage through the pelvis.
Question 23: Which of the following symptoms is least commonly associated with endometriosis?
- A. Vaginal discharge (Correct Answer)
- B. Infertility
- C. Chronic pelvic pain
- D. Dyspareunia
Explanation: ***Vaginal discharge*** - **Vaginal discharge** is a symptom more commonly associated with **infections or cervical issues**, rather than endometriosis. - While women with endometriosis may experience occasional discharge, it is **not a primary or characteristic symptom** of the condition itself. *Infertility* - **Infertility** is a very common issue for women with endometriosis, affecting their ability to conceive due to **inflammation, scarring, and anatomical distortion** of reproductive organs. - Endometrial implants can **disrupt ovarian function**, block fallopian tubes, and create a hostile uterine environment. *Chronic pelvic pain* - **Chronic pelvic pain** is the hallmark symptom of endometriosis, often severe and debilitating. - It results from the **inflammation, adhesions, and nerve sensitization** caused by ectopic endometrial tissue growing outside the uterus. *Dyspareunia* - **Dyspareunia**, or **painful intercourse**, is frequently experienced by women with endometriosis. - This symptom typically occurs when endometrial implants are located on the **uterosacral ligaments, posterior cul-de-sac, or rectovaginal septum**, leading to irritation during deep penetration.
Question 24: For routine diagnostic purposes, endometrial biopsy is usually done at which phase of the menstrual cycle?
- A. Just before menstruation (Correct Answer)
- B. 10-12 days after menstruation
- C. Just after menstruation
- D. At the time of ovulation
Explanation: ***Just before menstruation*** - An endometrial biopsy is typically performed in the **late secretory phase (just before menstruation)**. This timing is crucial for evaluating the endometrial response to progesterone and for detecting abnormalities that may be evident during this phase. - This timing allows for the assessment of the **full development of the secretory glands** and stroma, which can reveal issues like **inadequate luteal phase** or **endometrial hyperplasia** more clearly. *10-12 days after menstruation* - This time point corresponds to the mid-proliferative phase, where the endometrium is still growing under **estrogen influence**. - While suitable for evaluating proliferative changes, it might **miss subtle secretory phase abnormalities** or early signs of hyperplasia that are more evident later. *Just after menstruation* - This period is the early proliferative phase, where the endometrium is **thin and regenerating**. - Biopsying at this time might yield insufficient tissue for comprehensive evaluation and would be too early to assess **hormonal responses** that occur later in the cycle. *At the time of ovulation* - Ovulation marks the transition from the proliferative to the secretory phase, influenced by a surge in **luteinizing hormone (LH)**. - An endometrial biopsy at this phase would primarily show a proliferative endometrium and would not provide adequate information about the **key features of the secretory phase**, which are important for diagnostic purposes related to fertility or abnormal bleeding.
Question 25: Oligomenorrhoea means ?
- A. Cycle < 20 days
- B. Cycle more than 45 days
- C. Cycle more than 28 days
- D. Cycle longer than 35 days (Correct Answer)
Explanation: ***Cycle longer than 35 days*** - **Oligomenorrhea** is defined by menstrual cycles that are **infrequently occurring**, specifically lasting longer than 35 days. - This condition is distinct from **amenorrhea**, which is the complete absence of menstruation. *Cycle < 20 days* - A menstrual cycle lasting less than 20 days is considered **polymenorrhea**, indicating abnormally frequent menstruation. - This is the opposite of oligomenorrhea, which refers to infrequent menstruation. *Cycle more than 45 days* - While a cycle longer than 45 days would technically fall under **oligomenorrhea**, the general definition begins at an interval longer than **35 days**. - Cycles significantly longer than 45 days might also point to **amenorrhea**, depending on the exact duration and pattern. *Cycle more than 28 days* - A cycle lasting more than 28 days is within the **normal range** for many individuals, as the average cycle length is 21-35 days. - Therefore, this duration alone does **not define oligomenorrhea**.
Question 26: What is Hegar's sign in obstetrics?
- A. Uterine contractions
- B. Fetal movement
- C. Cyanosis of the vagina
- D. Softening of the uterine isthmus (Correct Answer)
Explanation: ***Softening of the uterine isthmus*** - **Hegar's sign** is an early presumptive sign of pregnancy characterized by the **softening of the lower uterine segment (isthmus)**, which can be palpated during a bimanual examination. - This softening makes the fundus and cervix feel like separate entities, indicating increased vascularity and changes due to hormonal influence. *Uterine contractions* - While contractions do occur during pregnancy (e.g., **Braxton Hicks contractions**), they are not what defines Hegar's sign. - **Uterine contractions** are typically associated with labor or placental abruption, not the specific softening of the isthmus. *Fetal movement* - **Fetal movement** (quickening) is a positive sign of pregnancy perceived by the mother, usually after 16-20 weeks gestation. - This is entirely distinct from Hegar's sign, which is a physical finding upon examination of the uterus. *Cyanosis of the vagina* - **Cyanosis of the vagina** and cervix is known as **Chadwick's sign**, another presumptive sign of pregnancy. - Chadwick's sign is due to increased vascularity and venous congestion, causing a bluish discoloration, but it's not the softening described in Hegar's sign.
Question 27: What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?
- A. Insufficient progesterone due to anovulation (Correct Answer)
- B. Excess estrogen production from ovarian follicles
- C. Hypothalamic dysfunction affecting ovulation
- D. High levels of progesterone due to luteal phase defect
Explanation: ***Insufficient progesterone due to anovulation*** - Anovulation prevents the formation of a **corpus luteum**, which is responsible for producing progesterone. - The lack of progesterone leads to an **unstable, proliferative endometrium** that eventually sheds irregularly, causing abnormal uterine bleeding. - This is the **primary hormonal defect** in anovulatory DUB. *Excess estrogen production from ovarian follicles* - While **unopposed estrogen** is present in anovulatory cycles, the primary issue is the *absence of progesterone*, not necessarily excess estrogen production. - Estrogen levels may be normal or even low, but without progesterone to stabilize the endometrium, irregular shedding occurs. - Excess estrogen primarily leads to **endometrial hyperplasia** rather than irregular bleeding. *Hypothalamic dysfunction affecting ovulation* - Hypothalamic dysfunction (e.g., due to stress, extreme exercise) can be an *underlying cause* of anovulation. - However, the *primary hormonal mechanism* of the bleeding itself is the subsequent lack of progesterone, not the hypothalamic dysfunction directly. *High levels of progesterone due to luteal phase defect* - A **luteal phase defect** involves *insufficient* progesterone production or response, not high levels. - High progesterone levels would stabilize the endometrium and promote regular shedding, preventing DUB.
Question 28: Commonest variety of compound presentation is?
- A. Head with hand (Correct Answer)
- B. Head with both feet
- C. Head, hand & feet
- D. Head with feet
Explanation: ***Head with hand*** - This is the **most frequent type** of compound presentation, where a fetal extremity (typically a hand) prolapses alongside the fetal head into the maternal pelvis. - It occurs due to factors that prevent the fetal head from snugly filling the pelvis, such as **cephalopelvic disproportion** or a **high fetal station**. *Head with foot* - While possible, the presentation of the **head with a foot** is less common than with a hand. - A foot alongside the head often suggests a more complex presentation or potential issues with fetal lie or attitude. *Head with both foot* - The simultaneous presentation of the **head with both feet** is exceedingly rare. - This scenario would indicate a profound degree of space for fetal extremities to descend alongside the head, possibly in cases of extreme prematurity or pelvic relaxation. *Head, hand & foot* - The combined presentation of the **head, a hand, and a foot** is extremely uncommon. - Such a complex presentation would suggest significant fetal mobility in a large pelvic space, making it a very rare occurrence in clinical practice.
Question 29: What is the best parameter for estimating fetal age by ultrasound in the third trimester?
- A. Abdominal circumference
- B. Femur length
- C. Intraocular distance
- D. BPD (Correct Answer)
Explanation: ***BPD (Biparietal Diameter)*** - **Biparietal diameter (BPD)** is considered the **best single parameter** among the given options for estimating fetal age in the third trimester, though all parameters become less accurate with advancing gestation. - In the third trimester, BPD accuracy is approximately **±3-4 weeks**, which is why **first trimester dating (CRL) should always be used when available** as it is most accurate (±5-7 days). - BPD is measured at the level of the thalami and cavum septum pellucidum, from outer edge of the proximal skull to the inner edge of the distal skull. - **Note**: Multiple biometric parameters used together improve accuracy more than any single measurement in late pregnancy. *Femur length* - **Femur length (FL)** is highly accurate in the **second trimester** but becomes less reliable in the third trimester due to biological variation. - It can be affected by **skeletal dysplasias** and genetic factors, leading to inaccurate age estimation. - FL is better used for assessing proportionate growth rather than dating in late pregnancy. *Abdominal circumference* - **Abdominal circumference (AC)** is primarily used for assessing **fetal growth and estimating fetal weight**, not for gestational age determination. - It is highly variable and influenced by fetal nutritional status, growth restriction, or macrosomia, making it unreliable for dating. - AC is the **most sensitive parameter for detecting growth abnormalities** (IUGR or LGA). *Intraocular distance* - **Intraocular distance (IOD)** is not a standard biometric parameter for routine gestational age estimation. - It has limited clinical utility and is occasionally used for detecting specific **fetal anomalies** (hypertelorism/hypotelorism) rather than dating. - Standard biometric parameters (BPD, HC, AC, FL) are always preferred for gestational age assessment.
Question 30: Ovarian reserve is best indicated by
- A. Follicle-stimulating hormone (FSH)
- B. Anti-Müllerian Hormone (AMH) (Correct Answer)
- C. Luteinizing hormone (LH)
- D. LH/FSH ratio
Explanation: ***Anti-Müllerian Hormone (AMH)*** - **AMH is currently considered the best single biochemical marker** for assessing ovarian reserve - Produced by **granulosa cells of preantral and small antral follicles**, directly reflecting the size of the primordial follicle pool - **Cycle-independent** - can be measured at any time during the menstrual cycle - **More sensitive and specific** than FSH for detecting diminished ovarian reserve - **Minimal inter-cycle and intra-cycle variability**, providing consistent and reliable results - Widely used in **fertility assessment, IVF protocols**, and predicting ovarian response to stimulation *Follicle-stimulating hormone (FSH)* - Elevated **early follicular phase FSH** (measured on day 3) indicates diminished ovarian reserve - Historically the most commonly used marker, but **less sensitive than AMH** - **Cycle-dependent** - must be measured on specific days (day 2-4 of cycle) - A **late marker** - rises only when ovarian reserve is already significantly diminished - Still clinically useful and widely available, but not the "best" indicator *Luteinizing hormone (LH)* - **LH** primarily triggers ovulation and does not directly reflect ovarian reserve - Elevated in conditions like **PCOS** but does not assess the quantity or quality of remaining follicles - Not a reliable indicator of overall ovarian reserve *LH/FSH ratio* - An elevated **LH/FSH ratio** (>2:1 or >3:1) is associated with **Polycystic Ovary Syndrome (PCOS)** - Reflects anovulation and hormonal imbalance, not the number or viability of ovarian follicles - Does not assess ovarian reserve capacity