NEET-PG 2015 - Obstetrics and Gynecology Practice Questions

Q: Uterine height is greater than gestational age of the patient in a case of all except -

IUGR. ***IUGR*** - In **Intrauterine Growth Restriction (IUGR)**, the fetus is smaller than expected for gestational age, leading to a **fundal height** that measures less than the actual gestational age. - This condition is characterized by a **restricted growth rate** of the fetus, causing the uterine size to be disproportionately small. *Fibroid uterus* - The presence of **uterine fibroids** (leiomyomas) can increase the overall size of the uterus beyond what would be expected for a given gestational age. - These benign tumors add bulk to the uterine wall, leading to a **larger-than-expected uterine height**. *Wrong dates* - Incorrect estimation of the **Last Menstrual Period (LMP)** or date of conception can lead to a miscalculation of gestational age. - If the gestational age is **underestimated**, the actual uterine height will appear greater than the calculated gestational age. *Polyhydramnios* - **Polyhydramnios** is a condition characterized by an **excessive accumulation of amniotic fluid**, which distends the uterus. - Increased amniotic fluid volume leads to a significantly **larger uterine size** and a fundal height greater than the gestational age.

Q: Which of the following is not considered a marker of ovarian reserve?

Inhibin A. ***Inhibin A*** - **Inhibin A** levels primarily rise during the mid to late luteal phase and are involved in regulating FSH, but they are not a reliable or commonly used marker for **ovarian reserve**. - Its fluctuations are more indicative of the presence of a **corpus luteum** and short-term ovarian function rather than the total follicular pool. *Inhibin B* - **Inhibin B** is produced by granulosa cells of small antral follicles and is an important marker of **ovarian reserve**. - It inversely correlates with **FSH** levels in the early follicular phase, reflecting the number of developing follicles. *Ovarian volume* - **Ovarian volume**, particularly when measured by ultrasound, can be an indicator of **ovarian reserve**. - Smaller ovarian volume is generally associated with a reduced number of **antral follicles** and lower ovarian reserve. *Anti-Müllerian Hormone (AMH)* - **AMH** is a well-established and highly reliable marker of **ovarian reserve**, produced by the granulosa cells of preantral and small antral follicles. - Its levels correlate directly with the total number of remaining **primordial follicles** and are relatively stable throughout the menstrual cycle.

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: What is the most common type of conjoint twin?

Thoracopagus. ***Thoracopagus*** - This type of conjoint twin, fused at the **thorax** and often sharing a heart and liver, is the **most common** variety, accounting for approximately **40%** of all cases. - The shared organs and complex anatomy often pose significant challenges for separation and survival. *Omphalopagus* - These twins are joined at the **abdomen** and typically share a liver, gastrointestinal tract, or other abdominal organs. - This is the second most common type, representing approximately **30-35%** of conjoint twins. *Craniopagus* - This rare form involves fusion at the **head**, often sharing parts of the skull, dura mater, or even brain tissue. - Due to the intricate neurological connections, craniopagus twins present exceptionally complex medical and ethical challenges, accounting for only **2-6%** of cases. *Rachipagus* - These twins are fused dorsally along the **spine** and typically share portions of the vertebral column and spinal cord. - This is an extremely rare type of conjoint twinning, representing less than **2%** of cases.

Q: Which of the following statements about chorionic villus sampling is false?

Is performed only in second trimester of pregnancy. ***Is performed only in second trimester of pregnancy*** - This statement is false because **chorionic villus sampling (CVS)** is typically performed earlier in pregnancy, specifically during the **first trimester**, usually between 10 and 13 weeks of gestation. - Performing CVS only in the second trimester would negate one of its main advantages: providing earlier genetic diagnostic information than **amniocentesis**. *Is used for prenatal genetic diagnosis* - **CVS** is a primary method for **prenatal genetic diagnosis**, allowing for the detection of chromosomal abnormalities and genetic disorders. - It involves analyzing fetal cells obtained from the **chorionic villi**. *Villi are collected from chorion frondosum* - The sample for **CVS** is indeed collected from the **chorion frondosum**, which is the fetal part of the placenta containing numerous chorionic villi. - These villi are genetically identical to the fetus, making them suitable for **genetic analysis**. *Can cause limb deformities* - There is a recognized, albeit small, risk of **limb reduction defects** associated with CVS, particularly if performed very early in gestation (before 9-10 weeks). - This risk is part of the counseling provided to prospective parents considering the procedure.

Q: Which of the following statements is true regarding placental site trophoblastic disease?

It secretes human placental lactogen. ***It secretes human placental lactogen*** - Placental site trophoblastic tumor (PSTT) characteristically consists of intermediate trophoblasts which secrete **human placental lactogen (hPL)**. - Unlike choriocarcinoma, PSTT secretes relatively low levels of **human chorionic gonadotropin (hCG)**. *Has a highly malignant potential* - PSTT generally has a **good prognosis** if the disease is confined to the uterus, with a survival rate of over 95%. - It has a low metastatic potential compared to choriocarcinoma, with metastases occurring in only about 15% of cases. *Mainly contains syncytiotrophoblasts* - PSTT is composed predominantly of **intermediate trophoblasts** that infiltrate the myometrium, rather than syncytiotrophoblasts or cytotrophoblasts. - The distinctive feature is the proliferation of these intermediate trophoblasts at the implantation site. *The treatment of choice is hysterectomy followed by chemotherapy* - **Hysterectomy** is generally the primary treatment for PSTT confined to the uterus, and it often cures the disease. - **Chemotherapy** is usually reserved for metastatic or recurrent disease, or in cases of extensive local invasion, and is not a routine follow-up after an uncomplicated hysterectomy.

Q: What is the recommended dose of folic acid for a patient with a history of neural tube defect (NTD) in a previous pregnancy?

4 mg. ***4 mg*** - For women with a prior history of a **neural tube defect (NTD)-affected pregnancy**, a higher dose of **4 mg of folic acid daily** is recommended to significantly reduce the risk of recurrence. - This increased dosage is crucial for achieving adequate maternal folate levels to prevent NTDs, starting at least one month before conception and continuing through the first trimester. *0.5 mg* - This dose is lower than the standard recommendation for women without a history of NTDs and is insufficient for high-risk individuals. - Suboptimal folic acid levels can still lead to a higher risk of NTD recurrence in patients with a history of NTD-affected pregnancies. *1 mg* - While 1 mg is higher than the general recommendation, it is still insufficient for women with a **history of NTD in a previous pregnancy**. - Current guidelines suggest a significantly higher dose for secondary prevention due to altered folate metabolism or higher requirements in these individuals. *2 mg* - This dose is also lower than the **established recommendation for high-risk women** who have had a previous NTD-affected pregnancy. - It does not provide the optimal level of protection required to reduce the risk of recurrence effectively.

Q: Which is not a risk factor for gestational hypertension

Smoking. ***Smoking*** - **Smoking** paradoxically shows a *protective effect* against gestational hypertension and preeclampsia, making it the correct answer as it is NOT a risk factor for gestational hypertension. - This well-documented phenomenon may be related to smoking's vasodilatory effects and reduced production of anti-angiogenic factors. - However, smoking carries numerous other serious risks including **intrauterine growth restriction (IUGR)**, **placental abruption**, **preterm birth**, and **perinatal mortality**. *Primigravida* - **Primigravida** (first pregnancy) is a well-established risk factor for gestational hypertension and preeclampsia. - First-time exposure to paternal antigens and incomplete immune tolerance may contribute to this increased risk. - The risk decreases in subsequent pregnancies with the same partner. *Factor V Leiden mutation* - The **Factor V Leiden mutation** is the most common inherited thrombophilia and significantly increases the risk of gestational hypertension and preeclampsia. - This mutation causes resistance to activated protein C, leading to a hypercoagulable state that can impair placental perfusion. - Associated with increased risk of venous thromboembolism during pregnancy. *Low maternal age* - **Low maternal age** (adolescent pregnancy, <20 years) is actually a recognized *risk factor* for gestational hypertension. - Young mothers may have incomplete physical and cardiovascular maturity to handle pregnancy-related physiological changes. - Adolescent pregnancies are associated with higher rates of hypertensive disorders of pregnancy.

Q: Following delivery, a tear involving the perineum and external anal sphincter with intact mucosa is classified as which grade?

Third degree. ***Third degree*** - A third-degree perineal tear involves the **perineum** and the **external anal sphincter (EAS)**, either partially or completely, while the **anal mucosa remains intact**. - This classification is crucial for determining the necessary repair technique and predicting potential long-term complications related to **anal incontinence**. *First degree* - A first-degree tear involves only the **skin** of the perineum and the **vaginal mucosa**, without involving the underlying muscle. - These tears are typically superficial and may not even require suturing. *Second degree* - A second-degree tear involves the **perineal muscles** but does not extend to the anal sphincter. - It includes the vaginal mucosa, perineal skin, and muscles but spares the **external anal sphincter**. *Fourth degree* - A fourth-degree tear is the most severe, involving the **perineum**, **external anal sphincter**, and extending through the **anal mucosa**, exposing the rectal lumen. - These tears carry the highest risk of **fecal incontinence** and require meticulous surgical repair.

Question 1

Uterine height is greater than gestational age of the patient in a case of all except -

Accepted Answer

IUGR

Answer

Fibroid uterus

Answer

Wrong dates

Answer

Polyhydramnios

Question 2

Which of the following is not considered a marker of ovarian reserve?

Accepted Answer

Inhibin A

Answer

Ovarian volume

Answer

Inhibin B

Answer

Anti-Müllerian Hormone (AMH)

Question 3

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 4

What is the most appropriate management for a 28-year-old hemodynamically stable patient with mild abdominal pain and an unruptured tubal ectopic pregnancy measuring 2.5 x 3 cm, with β-hCG level of 8500 mIU/mL, visible fetal cardiac activity, and who desires future fertility?

Accepted Answer

Laparoscopic salpingostomy

Answer

Methotrexate therapy

Answer

Laparoscopic salpingectomy

Answer

Expectant management

Question 5

What is the most common type of conjoint twin?

Accepted Answer

Thoracopagus

Answer

Omphalopagus

Answer

Craniopagus

Answer

Rachipagus

Question 6

Which of the following statements about chorionic villus sampling is false?

Accepted Answer

Is performed only in second trimester of pregnancy

Answer

Can cause limb deformities

Answer

Is used for prenatal genetic diagnosis

Answer

Villi are collected from chorion frondosum

Question 7

Which of the following statements is true regarding placental site trophoblastic disease?

Accepted Answer

It secretes human placental lactogen

Answer

Has a highly malignant potential

Answer

Mainly contains syncytiotrophoblasts

Answer

The treatment of choice is hysterectomy followed by chemotherapy

Question 8

What is the recommended dose of folic acid for a patient with a history of neural tube defect (NTD) in a previous pregnancy?

Accepted Answer

4 mg

Answer

0.5 mg

Answer

1 mg

Answer

2 mg

Question 9

Which is not a risk factor for gestational hypertension

Accepted Answer

Smoking

Answer

Primigravida

Answer

Factor V Leiden mutation

Answer

Low maternal age

Question 10

Following delivery, a tear involving the perineum and external anal sphincter with intact mucosa is classified as which grade?

Accepted Answer

Third degree

Answer

First degree

Answer

Second degree

Answer

Fourth degree

NEET-PG 2015 — Obstetrics and Gynecology