NEET-PG 2015 - Obstetrics and Gynecology Practice Questions

Q: Which of the following methods is not used for managing shoulder dystocia?

Hegar's maneuver. *McRobert's maneuver* - This maneuver is a common first-line intervention for shoulder dystocia, involving sharp **flexion of the mother's hips** back towards her abdomen to flatten the sacrum and rotate the symphysis pubis anteriorly. - It works by increasing the functional diameter of the **pelvic outlet**, potentially dislodging the anterior shoulder. ***Hegar's maneuver*** - **Hegar's sign** is a clinical finding related to early pregnancy, indicating the **softening of the lower uterine segment** (isthmus) upon bimanual examination. - It is a diagnostic sign of pregnancy and **not a method used to resolve shoulder dystocia**. *Zavanelli maneuver* - The **Zavanelli maneuver** is a last-resort intervention for shoulder dystocia, involving the **replacement of the fetal head into the uterus** followed by immediate delivery via **cesarean section**. - This is a highly invasive procedure with significant risks to both mother and fetus, used when other maneuvers have failed. *Wood's maneuver* - **Wood's maneuver** involves **rotating the fetal shoulders** by applying pressure to the posterior aspect of the anterior shoulder or the anterior aspect of the posterior shoulder to achieve a corkscrew effect. - This rotation can help dislodge an impacted shoulder or facilitate its passage under the symphysis pubis.

Q: What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?

24-48 hours. ***24-48 hours*** - The FDA-approved protocol for medical abortion with mifepristone and misoprostol specifies a **24- to 48-hour interval** between the administration of the two drugs. - This timing ensures optimal efficacy as it allows mifepristone to adequately sensitize the uterus to the effects of misoprostol. *48 hours* - While 48 hours falls within the recommended range, specifically stating "48 hours" as the only option is less precise than the **24-48 hour window**. - No specific clinical advantage or disadvantage is generally reported for waiting exactly 48 hours over, for instance, 24 hours. *96 hours* - A 96-hour interval is significantly longer than the **FDA-recommended window** and is not part of the standard, evidence-based protocol. - Delaying misoprostol administration beyond 48 hours may **reduce the effectiveness** of the medical abortion and increase the risk of complications. *72 hours* - A 72-hour interval exceeds the upper limit of the **FDA-recommended window** for optimal efficacy. - While some studies have explored extended intervals, the *standard clinical practice* and FDA guidelines do not endorse 72 hours as the primary recommended interval.

Q: The best method for inducing mid trimester abortion is :

Prostaglandins. ***Prostaglandins*** - **Prostaglandins** (e.g., dinoprostone, misoprostol) are highly effective in inducing uterine contractions and cervical ripening, making them the preferred method for **mid-trimester abortion**. - They can be administered through various routes (vaginal, oral, buccal) and offer a good balance of efficacy and safety for this gestational age. - Prostaglandins are considered the **current gold standard** for second-trimester medical termination of pregnancy. *Injection of Hypertonic Saline* - Historically used, but **intra-amniotic hypertonic saline** carries significant risks, including hypernatremia, disseminated intravascular coagulation (DIC), and uterine rupture. - It has largely been replaced by safer and more effective methods like prostaglandins due to its adverse event profile. - This method is now considered obsolete in most clinical settings. *Ethacrydine Lactate* - **Ethacrydine lactate** (ethacridine lactate/Rivanol) is an antiseptic agent that was historically used for mid-trimester abortion via intra-amniotic injection. - While it was effective in inducing abortion, it has been largely abandoned due to complications, prolonged induction time, and the availability of safer alternatives. - It is **not the preferred method** compared to prostaglandins, which have better safety profiles and efficacy. *Dilation and Curettage (D&C)* - **Dilation and curettage (D&C)** is primarily used for first-trimester abortions or for managing incomplete abortions and miscarriages. - In the mid-trimester, the uterus is larger and the fetal tissue is more substantial, making D&C less safe and often requiring extensive dilation or potentially leading to complications like uterine perforation or hemorrhage. - **Dilation and evacuation (D&E)** may be used in mid-trimester but requires specialized training and equipment.

Q: Which of the following conditions is ruled out in a twin pregnancy of the same age and sex?

Superfetation. ***Superfetation*** - **Superfetation** refers to the fertilization of an ovum when another pregnancy is already established in the uterus, resulting in two fetuses of **different gestational ages**. - As the question specifies a twin pregnancy of the **same age**, superfetation is ruled out. *Monozygotic twins* - **Monozygotic twins** originate from a single zygote that splits, resulting in genetically identical individuals of the **same sex** and age. - This condition is consistent with the given scenario of same-sex, same-aged twins. *Superfecundation* - **Superfecundation** is the fertilization of two or more ova from the same ovulatory cycle by sperm from **different acts of coitus** (which may involve different partners). - The twins are of the **same gestational age** (same cycle) but are **dizygotic**, and can be either the same sex or different sexes. - This condition is NOT ruled out by the criteria given in the question. *None of the following* - This option is incorrect because **superfetation** is definitively ruled out by the criteria of the question (twins of the same age).

Q: Duration of second stage of labor (propulsive stage) in multipara

Approximately 20 minutes. ***Approximately 20 minutes*** - In **multiparas**, the second stage of labor, also known as the **propulsive stage**, is typically shorter due to prior experience with childbirth. - While there is variability, an average duration of **20 minutes** for this stage is commonly observed in multiparous women. *40 minutes* - A duration of 40 minutes for the propulsive stage would be considered on the longer side for a **multipara**, often approaching the upper limits of normal. - While not necessarily abnormal, it is longer than the **average expected time** for multiparous women. *1 hour* - A second stage duration of **1 hour** in a multipara would generally be considered prolonged and might warrant intervention or closer monitoring. - This duration is more consistent with the **upper limit of normal** in nulliparous women or cases of arrest of labor in multiparas. *10 minutes* - While some multiparous women may have a very rapid second stage, **10 minutes** is on the shorter end of the average. - This could indicate a **precipitous labor**, which can carry its own risks such as maternal lacerations and neonatal complications.

Q: What would be the type of presentation when the engaging diameter is mentovertical?

Brow. ***Brow*** - The **mentovertical diameter** (13.5 cm) is the engaging diameter in **brow presentation**. - This diameter extends from the **chin (mentum) to the vertex** of the fetal head. - Brow presentation occurs when the fetal head is **partially deflexed**, presenting the area between the orbital ridge and the anterior fontanelle. - This is the **largest anteroposterior diameter** of the fetal head and makes vaginal delivery extremely difficult or impossible. *Face* - In **face presentation**, the fetal head is **completely hyperextended**, and the engaging diameter is **submentobregmatic** (9.5 cm), not mentovertical. - This diameter extends from below the chin to the bregma. - Face presentation can allow vaginal delivery if the mentum is anterior. *Vertex* - **Vertex presentation** is the most common and favorable presentation, with the fetal head fully flexed. - The engaging diameter is **suboccipitobregmatic** (9.5 cm), from the subocciput to the bregma. - The occiput presents first in this presentation. *Breech* - **Breech presentation** involves the fetal buttocks or feet presenting first. - The engaging diameter is **bitrochanteric** (transverse diameter), not related to cephalic diameters like mentovertical.

Q: Which of the following statements about abdominal pregnancy is true?

Leaving the placenta behind can lead to infection.. ***f6629bc8-61b2-4393-bb4c-9c32cd943e34*** - **Placenta acreta-like implantation** of the placenta into intra-abdominal organs or the abdominal wall makes removal dangerous due to potential damage and massive hemorrhage. - While leaving it in place can lead to serious complications like **infection**, **abscess formation**, or **secondary hemorrhage** as it degenerates, the risks of immediate removal often outweigh these, necessitating careful observation and management. *020c0067-d7b2-4fc2-85ae-2d6ba40ab437* - **Primary abdominal pregnancy** is extremely rare, accounting for less than 1% of all extrauterine pregnancies. - Abdominal pregnancies are generally **secondary** due to tubal abortion or rupture with subsequent reimplantation. *3560b92d-a63d-4966-8872-e4f56a82882f* - **Fetal survival rates** in abdominal pregnancies are very low, with a high incidence of **fetal anomalies** and **perinatal mortality**. - The abnormal placental implantation and lack of amniotic fluid protection lead to significant **growth restriction** and compression deformities. *5ab987e0-68ca-43f2-a8f2-238a5eb0c4f8* - The decision to remove the **placenta** in an abdominal pregnancy is complex and depends on its implantation site; often, it is left in situ due to the high risk of **hemorrhage** from attempting removal. - Removing the placenta can cause **uncontrollable bleeding**, especially if it is attached to vital organs or large blood vessels.

Q: A 45-year-old female with a history of G5P4A0L4 has her last menstrual period (LMP) on August 25, 2014. What is the gestational age in weeks on May 11, 2015?

37 weeks. ***37 weeks*** - Calculating from **LMP (August 25, 2014)** to assessment date **(May 11, 2015)**: Days remaining in August: 6 days (26th-31st), September through April: 242 days, Days in May: 11 days. - **Total: 259 days ÷ 7 = exactly 37 weeks** gestational age using standard **Naegele's rule** calculation method. *32 weeks* - This option would correspond to an assessment date in early April 2015, which is **too early** given the LMP and assessment date. - It suggests a **5-week shorter** pregnancy duration than the actual interval calculated. *35 weeks* - This option indicates an assessment around the third week of April 2015, which is still **earlier** than the May 11, 2015, date. - It implies a **2-week shorter** gestational period than the correct calculation shows. *40 weeks* - This option would correspond to an assessment date in early June 2015, **beyond** the May 11, 2015, assessment date. - This gestational age is **too long** for the specified dates and would suggest the patient is at **term** or past her due date.

Q: Which of the following ovarian tumors is most prone to undergo torsion during pregnancy?

Dermoid cyst. ***Dermoid cyst*** - **Dermoid cysts**, or mature cystic teratomas, are the **most common ovarian tumors** to undergo torsion, especially during pregnancy due to their mobility and moderate size. - They are often **unilateral** and benign, containing various mature tissues such as hair, teeth, and sebaceous material. *Serous cystadenoma* - While common, **serous cystadenomas** are generally **less mobile** than dermoid cysts and thus have a lower propensity for torsion. - They are typically filled with **clear, watery fluid** and can grow to be quite large. *Mucinous cystadenoma* - **Mucinous cystadenomas** tend to be **larger** than dermoid cysts and are less prone to torsion due to their size and often fixed position within the pelvis. - They are filled with **thick, gelatinous mucin** and can reach massive sizes, sometimes filling the entire abdominal cavity. *Theca lutein cyst* - **Theca lutein cysts** are usually **bilateral** and occur with conditions like **gestational trophoblastic disease** or **ovarian hyperstimulation**. - While they can be large, their often bilateral nature and underlying pathological conditions make them **less likely to independently twist** as a primary event compared to a freely mobile dermoid cyst.

Question 1

Which of the following methods is not used for managing shoulder dystocia?

Accepted Answer

Hegar's maneuver

Answer

Zavanelli maneuver

Answer

Wood's maneuver

Answer

McRobert's maneuver

Question 2

What is the primary clinical advantage of the occipitoanterior position in childbirth?

Accepted Answer

It allows optimal fetal head flexion reducing the presenting diameter.

Answer

It is the most favorable position for vaginal delivery.

Answer

Anterior fontanelle is anterior in this position.

Answer

It is associated with shorter labor duration and fewer complications.

Question 3

What is the FDA-recommended time interval between Mifepristone and Misoprostol administration in medical termination of pregnancy?

Accepted Answer

24-48 hours

Answer

96 hours

Answer

48 hours

Answer

72 hours

Question 4

The best method for inducing mid trimester abortion is :

Accepted Answer

Prostaglandins

Answer

Dilation and Curettage (D&C)

Answer

Injection of Hypertonic Saline

Answer

Ethacrydine Lactate

Question 5

Which of the following conditions is ruled out in a twin pregnancy of the same age and sex?

Accepted Answer

Superfetation

Answer

Monozygotic twins

Answer

Superfecundation

Answer

None of the following

Question 6

Duration of second stage of labor (propulsive stage) in multipara

Accepted Answer

Approximately 20 minutes

Answer

40 minutes

Answer

1 hour

Answer

10 minutes

Question 7

What would be the type of presentation when the engaging diameter is mentovertical?

Accepted Answer

Brow

Answer

Face

Answer

Vertex

Answer

Breech

Question 8

Which of the following statements about abdominal pregnancy is true?

Accepted Answer

Leaving the placenta behind can lead to infection.

Answer

Primary abdominal pregnancy is a common condition.

Answer

Most fetuses in abdominal pregnancies survive to term.

Answer

Separation of the placenta is always necessary.

Question 9

A 45-year-old female with a history of G5P4A0L4 has her last menstrual period (LMP) on August 25, 2014. What is the gestational age in weeks on May 11, 2015?

Accepted Answer

37 weeks

Answer

32 weeks

Answer

35 weeks

Answer

40 weeks

Question 10

Which of the following ovarian tumors is most prone to undergo torsion during pregnancy?

Accepted Answer

Dermoid cyst

Answer

Serous cystadenoma

Answer

Mucinous cystadenoma

Answer

Theca lutein cyst

NEET-PG 2015 — Obstetrics and Gynecology