All are true about constriction rings except which of the following?
What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?
Which of the following symptoms is least commonly associated with endometriosis?
USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?
In which stage of cervical carcinoma is surgery performed to retain the possibility of conception?
Bishop scoring is done for ?
What does teratozoospermia refer to?
Ovarian reserve is best indicated by
Which type of pelvis is most commonly associated with dystocia?
NEET-PG 2013 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 71: All are true about constriction rings except which of the following?
- A. Can be caused by excessive use of oxytocin.
- B. Also known as Schroeder's ring. (Correct Answer)
- C. Ring can be palpated per abdomen
- D. Inhalation of amyl nitrate can relax the ring.
Explanation: ***Also known as Schroeder's ring.*** - This statement is **INCORRECT** and is the correct answer to this "except" question. - **Schroeder's ring** is NOT synonymous with constriction rings. Schroeder's ring is a **physiological retraction ring** at the junction of the upper and lower uterine segments, which is a normal finding. - **Constriction rings** are **pathological, localized spastic contractions** of the uterine muscle at any level, causing obstruction to fetal descent. They differ from Bandl's pathological retraction ring. *Can be caused by excessive use of oxytocin.* - **Excessive oxytocin** can lead to **uterine hyperstimulation** and **incoordinate uterine contractions**, which may result in the formation of constriction rings. - This is a known iatrogenic cause of pathological constriction rings during labor. *Ring can be palpated per abdomen* - **Constriction rings** can sometimes be palpated as a **depression or groove** on the uterine surface during abdominal examination when they are well-developed. - They present as localized areas of myometrial spasm that may be clinically detectable. *Inhalation of amyl nitrate can relax the ring.* - **Amyl nitrite** (or amyl nitrate) is a **smooth muscle relaxant** that can be used to relax uterine constriction rings. - It acts as a **vasodilator** and **uterine relaxant**, temporarily relieving the spastic contraction to facilitate delivery or manual manipulation.
Question 72: What is the preferred treatment option for a 21-year-old college girl with mild endometriosis?
- A. Cyclical OC pill
- B. Continuous OC pill (Correct Answer)
- C. Progesterone only pill
- D. Danazole
Explanation: ***Continuous OC pill*** - For **mild endometriosis** in a young woman, **continuous oral contraceptive pills (OCP)** are the **first-line medical treatment** according to current evidence-based guidelines (ACOG, ESHRE). - Continuous OCP use provides better suppression of endometriosis by creating a **stable hormonal environment** that prevents cyclic menstrual bleeding and retrograde menstruation, which can worsen endometriosis. - This approach effectively manages symptoms like **dysmenorrhea** and **pelvic pain** while preserving future fertility, and is well-tolerated in young women with the added benefit of menstrual suppression. *Cyclical OC pill* - While cyclical OCPs can help manage endometriosis symptoms, they are **less effective** than continuous OCPs because they allow withdrawal bleeding, which may perpetuate retrograde menstruation and endometrial implant stimulation. - Cyclical OCPs may still provide symptom relief but are considered a **second-line option** when continuous use is not acceptable to the patient. *Progesterone only pill* - **Progesterone-only pills (POP)** can suppress endometriosis by inducing amenorrhea and decidualization of endometrial implants, but they may cause **irregular bleeding patterns**, especially in the first few months. - While effective, they are generally considered when combined OCPs are contraindicated (e.g., migraine with aura, thrombotic risk) rather than as first-line for uncomplicated mild endometriosis. *Danazole* - **Danazol** is an androgenic agent that creates a hypoestrogenic environment, leading to atrophy of endometrial tissue, but it is **rarely used today** due to significant androgenic side effects. - Common side effects include **acne**, **hirsutism**, **weight gain**, and **voice deepening**, which are often unacceptable for a 21-year-old woman, making it an obsolete option for first-line management of mild endometriosis.
Question 73: 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 74: USG of 28 weeks gestation showing oligohydramnios is likely to be due to?
- A. Renal pathway obstruction (Correct Answer)
- B. Neuromuscular disorder
- C. Gastrointestinal obstruction
- D. Anencephaly
Explanation: ***Renal pathway obstruction*** - **Oligohydramnios** (low amniotic fluid) in the late second or third trimester is often caused by conditions that impair fetal urine production or outflow. - **Renal pathway obstruction** (e.g., posterior urethral valves, bilateral renal agenesis) prevents the fetus from producing or excreting sufficient urine, a primary source of amniotic fluid. *Gastrointestinal obstruction* - **Gastrointestinal obstruction** is more commonly associated with **polyhydramnios** because it impairs the fetal swallowing of amniotic fluid. - Inability to swallow leads to an *accumulation* of amniotic fluid, not a reduction. *Anencephaly* - **Anencephaly** is typically associated with **polyhydramnios** due to impaired swallowing of amniotic fluid. - The exposed brain tissue can also lead to increased fluid transudation. *Neuromuscular disorder* - **Neuromuscular disorders** can cause **polyhydramnios** if they lead to impaired fetal swallowing due to muscle weakness. - If a neuromuscular disorder affects the renal system, it could potentially cause oligohydramnios, but it is not the primary cause of oligohydramnios itself.
Question 75: 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 76: In which stage of cervical carcinoma is surgery performed to retain the possibility of conception?
- A. Stage 1B1 (Correct Answer)
- B. Stage 1B2
- C. Stage 2A
- D. Stage 2B
Explanation: ***Stage 1B1*** - In **Stage 1B1 cervical carcinoma** (FIGO 2018), the tumor size is **≤2 cm** and confined to the cervix, making it amenable to **fertility-sparing surgery** like radical trachelectomy. - This stage allows for removal of the cervix and parametrium while preserving the **uterine body** and ovaries, thus retaining the possibility of conception. - Strict selection criteria must be met including tumor size ≤2 cm, no lymphovascular space invasion, negative lymph nodes, and adequate follow-up compliance. *Stage 1B2* - **Stage 1B2** (FIGO 2018) involves tumors **>2 cm to ≤4 cm** but still confined to the cervix, which generally have a higher risk of recurrence and lymph node metastasis. - While fertility-sparing surgery might be considered in highly selective cases with tumors 2-3 cm, it is much less commonly performed than in Stage 1B1 due to the increased tumor burden and higher oncological risk. *Stage 2A* - In **Stage 2A cervical carcinoma**, the tumor has spread beyond the cervix to involve the upper two-thirds of the vagina (2A1: ≤4 cm, 2A2: >4 cm) but not the parametrium. - The disease extent typically necessitates more aggressive treatment such as radical hysterectomy or **chemoradiation**, precluding preservation of fertility in most cases. *Stage 2B* - **Stage 2B** involves tumor invasion into the **parametrium**, making fertility-sparing surgery contraindicated and typically requiring **definitive chemoradiation**. - The spread of cancer to the parametrium indicates a more advanced disease that cannot be adequately treated by methods that preserve fertility.
Question 77: Bishop scoring is done for ?
- A. Exchange transfusion in newborns
- B. Newborn ventilation assessment
- C. Newborn gestation assessment
- D. Induction of labor assessment (Correct Answer)
Explanation: ***Induction of labor assessment*** - The **Bishop score** is a pre-labor scoring system used to assess the ripeness of the cervix. - A higher score indicates a more **favorable cervix** for the successful **induction of labor**. *Exchange transfusion in newborns* - **Exchange transfusion** is primarily indicated for severe hyperbilirubinemia or hemolytic disease in newborns. - Its assessment is based on **bilirubin levels** and other clinical factors, not the Bishop score. *Newborn ventilation assessment* - **Newborn ventilation assessment** involves evaluating respiratory effort, heart rate, and oxygenation status, often using scores like the **Apgar score**. - The Bishop score is unrelated to neonatal respiratory function. *Newborn gestation assessment* - **Newborn gestation assessment** is typically performed using methods like the **New Ballard Score** or by reviewing prenatal ultrasound dating. - The Bishop score is used in *maternal* obstetric management, not directly for neonatal gestational age estimation.
Question 78: What does teratozoospermia refer to?
- A. Low sperm count
- B. Sperm with abnormal motility
- C. Absence of sperm in semen
- D. Morphologically defective sperm (Correct Answer)
Explanation: ***Morphologically defective sperm*** - **Teratozoospermia** specifically refers to the presence of an unusually high percentage of **abnormally shaped sperm** in an ejaculate. - These malformations can affect the **head, midpiece, or tail** of the sperm, potentially impairing its ability to fertilize an egg. *Low sperm count* - This condition is known as **oligozoospermia**, which refers to a sperm concentration below the normal range. - While low sperm count can affect fertility, it is distinct from issues with sperm morphology. *Sperm with abnormal motility* - This condition is called **asthenozoospermia**, characterized by reduced or absent sperm movement. - Poor motility impacts the sperm's ability to reach and penetrate the egg, but it is not directly related to sperm shape. *Absence of sperm in semen* - The complete absence of sperm in the ejaculate is known as **azoospermia**. - This is a severe form of male infertility, different from having sperm with structural defects.
Question 79: 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
Question 80: 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.