NEET-PG 2013 - Obstetrics and Gynecology Practice Questions

Q: USG of 28 weeks gestation showing oligohydramnios is likely to be due to?

Renal pathway obstruction. ***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.

Q: What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?

Insufficient progesterone due to anovulation. ***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.

Q: In which stage of cervical carcinoma is surgery performed to retain the possibility of conception?

Stage 1B1. ***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.

Q: At which gestational week does the maximum volume of amniotic fluid occur?

36 weeks. ***36 weeks*** - The volume of **amniotic fluid** gradually increases during pregnancy, reaching its **peak** around **36 weeks** of gestation. - After 36 weeks, the volume of amniotic fluid typically begins to **decrease** as the pregnancy approaches term. *32 weeks* - At 32 weeks, the amniotic fluid volume is still **increasing** and has not yet reached its maximum level. - The fetus is actively growing and contributing to fluid production, but the peak is still several weeks away. *34 weeks* - Although significant, the amniotic fluid volume at 34 weeks has not yet reached its **maximum**. - The volume will continue to rise for another two weeks before plateauing and then declining. *40 weeks* - By 40 weeks, a normal-term pregnancy, the volume of amniotic fluid has typically **decreased** from its peak at 36 weeks. - A declining amniotic fluid volume (oligohydramnios) can be a concern at term if it's too low.

Q: Rule of Hasse is used to determine:

Fetal age estimation. ***Fetal age estimation*** - **Rule of Hasse** is specifically used for estimating the **fetal age** in forensic cases involving remains of an unborn fetus. - It relates the crown-heel length of the fetus in centimeters to its age in lunar months (first 5 lunar months) or halves of lunar months (second 5 lunar months). *Adult height measurement* - Adult height is typically measured directly or estimated using long bone lengths, an entirely different set of methods from Hasse's Rule. - This rule is specific to the **developing fetus** and not applicable to adults. *Determination of ethnicity* - Ethnicity determination involves analyzing skeletal features, particularly of the skull and pelvis, and is not related to fetal length or age estimation. - Hasse's Rule provides an age estimate based on size, not ancestral origin. *General forensic identification* - While forensic identification is a broad field, Hasse's Rule is a very specific tool for **fetal age assessment**, not general adult identification. - General forensic identification involves techniques like DNA analysis, fingerprinting, and skeletal remains analysis for adults.

Q: Borax causes which of the following effects?

Causes gastrointestinal irritation (side effect). ***Causes gastrointestinal irritation (side effect)*** - Borax, specifically its component **boric acid**, is rapidly absorbed through the **gastrointestinal tract** and can cause symptoms like nausea, vomiting, and diarrhea even in small amounts. - This **gastrointestinal irritation** is a common sign of acute borax toxicity. *Induces uterine contractions (labor-inducing)* - While certain substances can induce uterine contractions, **borax is not known** or traditionally used for this purpose. - It is **not an oxytocic agent** and does not act on uterine smooth muscle in a way that would induce labor. *Irritates genitourinary tract (side effect)* - Although borax can be toxic, its primary route of significant irritation and toxicity is not typically the **genitourinary tract** in the way implied for adverse effects. - While it can be absorbed through mucous membranes, the genitourinary tract is not its primary target for **direct irritant effects** in systemic exposure. *Traditionally used to stimulate menstrual flow* - There is **no reliable scientific or traditional medical evidence** to support the use of borax to stimulate menstrual flow. - Substances used for this purpose, known as **emmenagogues**, are typically herbal or pharmaceutical preparations, and borax is **not among them**.

Q: Uterine rupture is most common in -

Anterior lower segment. ***Anterior lower segment*** - The **anterior lower segment** is the most common site for **uterine rupture** due to prior **cesarean sections** or other uterine surgeries which are often performed anteriorly. - This area is thinner and more prone to stretching and tearing during labor, especially in cases of repeated surgical scars. *Posterior lower segment* - While rupture can occur in the **posterior lower segment**, it is less common than the anterior location. - This area is usually less stressed by previous surgical incisions compared to the anterior wall. *Upper uterine segment* - Rupture in the **upper uterine segment** typically involves an **unscarred uterus** and is a rare event, often associated with a **grand multiparous patient** or **oxytocin hyperstimulation**. - This type of rupture is usually spontaneous and more catastrophic due to the rich vascularity of the upper segment. *Lateral uterine wall* - Rupture of the **lateral uterine wall** is uncommon and usually associated with **trauma** or **manual extraction of the placenta**, rather than prior surgical scars. - It is not the most frequent site for spontaneous or scar-related uterine rupture.

Q: Which nerve block is given in forceps delivery?

Pudendal. ***Pudendal*** - A **pudendal block** anesthetizes the **perineum, vulva, and lower vagina**, providing pain relief for instrumental deliveries like **forceps delivery** and for episiotomy. - It involves injecting a local anesthetic near the **pudendal nerve** as it passes posterior to the **ischial spine**. *Posterior femoral* - The **posterior femoral cutaneous nerve** primarily innervates the skin of the posterior thigh and part of the perineum but does not provide sufficient deep analgesia for a forceps delivery. - Blocking this nerve alone would not adequately cover the extensive area affected during instrumental delivery. *Genitofemoral* - The **genitofemoral nerve** primarily innervates the skin of the upper medial thigh and parts of the genitalia but is not the primary nerve for pain relief during vaginal delivery procedures. - Its blockade would not provide the comprehensive analgesia needed for a forceps delivery. *Ilio inguinal* - The **ilioinguinal nerve** innervates the skin of the groin, mons pubis, and labia majora but does not provide sufficient anesthesia for the deeper structures involved in a forceps delivery. - An ilioinguinal nerve block is more commonly used for pain control in procedures involving the groin or hernia repair, not for instrumental vaginal delivery.

Q: When should semen analysis be done?

After liquefaction with thorough mixing. ***After liquefaction with thorough mixing*** - Semen analysis should be performed **after complete liquefaction** (typically within 20-30 minutes, maximum 60 minutes) followed by **thorough mixing**. - According to **WHO guidelines (2010, 2021)**, the sample must first liquefy completely at room temperature, then be mixed well before microscopic examination. - This ensures accurate assessment of **sperm concentration, motility, and morphology** without artifacts from viscous semen. - The standard practice is to examine within **60 minutes of collection** but only after liquefaction is complete. *After 30-60 mins irrespective of liquefaction* - The phrase "irrespective of liquefaction" is **incorrect** as analysis before complete liquefaction leads to inaccurate results. - Performing analysis on a non-liquefied sample can cause **underestimation of sperm motility** and difficulty in proper microscopic assessment. - Liquefaction status must be assessed before proceeding with analysis. *As early as possible* - Analyzing too early before **liquefaction** (which typically takes 20-30 minutes) will yield inaccurate results. - A viscous, non-liquefied sample impairs proper **sperm movement assessment** and mixing. *After 15-30 mins irrespective of liquefaction* - While 30 minutes may be sufficient for many samples to liquefy, the phrase "irrespective of liquefaction" makes this incorrect. - Some samples may require up to **60 minutes** to liquefy completely, and analysis should not proceed until liquefaction is confirmed.

Question 1

USG of 28 weeks gestation showing oligohydramnios is likely to be due to?

Accepted Answer

Renal pathway obstruction

Answer

Neuromuscular disorder

Answer

Gastrointestinal obstruction

Answer

Anencephaly

Question 2

What is the primary hormonal cause of anovulatory dysfunctional uterine bleeding (DUB)?

Accepted Answer

Insufficient progesterone due to anovulation

Answer

Excess estrogen production from ovarian follicles

Answer

Hypothalamic dysfunction affecting ovulation

Answer

High levels of progesterone due to luteal phase defect

Question 3

In which stage of cervical carcinoma is surgery performed to retain the possibility of conception?

Accepted Answer

Stage 1B1

Answer

Stage 1B2

Answer

Stage 2A

Answer

Stage 2B

Question 4

At which gestational week does the maximum volume of amniotic fluid occur?

Accepted Answer

36 weeks

Answer

32 weeks

Answer

34 weeks

Answer

40 weeks

Question 5

Rule of Hasse is used to determine:

Accepted Answer

Fetal age estimation

Answer

Adult height measurement

Answer

Determination of ethnicity

Answer

General forensic identification

Question 6

Borax causes which of the following effects?

Accepted Answer

Causes gastrointestinal irritation (side effect)

Answer

Induces uterine contractions (labor-inducing)

Answer

Irritates genitourinary tract (side effect)

Answer

Traditionally used to stimulate menstrual flow

Question 7

Uterine rupture is most common in -

Accepted Answer

Anterior lower segment

Answer

Posterior lower segment

Answer

Upper uterine segment

Answer

Lateral uterine wall

Question 8

Which nerve block is given in forceps delivery?

Accepted Answer

Pudendal

Answer

Posterior femoral

Answer

Genitofemoral

Answer

Ilioinguinal

Question 9

When should semen analysis be done?

Accepted Answer

After liquefaction with thorough mixing

Answer

After 30-60 mins irrespective of liquefaction

Answer

As early as possible

Answer

After 15-30 mins irrespective of liquefaction

NEET-PG 2013 — Obstetrics and Gynecology