NEET-PG 2015 - Obstetrics and Gynecology Practice Questions

Q: Which of the following conditions is most commonly associated with malodorous vaginal discharge?

Bacterial vaginosis. ***Bacterial vaginosis*** - This condition is characterized by a "fishy" or **malodorous vaginal discharge**, particularly noticeable after intercourse due to the release of amines. - It results from an imbalance in the vaginal flora, with an overgrowth of anaerobic bacteria and a decrease in protective lactobacilli. *Chlamydia trachomatis* - Often presents with **asymptomatic cervicitis** or mild watery discharge; **malodorous discharge** is not a common or prominent symptom. - While it can cause pelvic pain or dysuria, it's not typically associated with the characteristic smell of bacterial vaginosis. *Trichomonas vaginalis* - Can cause a **frothy, yellow-green discharge** that may be malodorous, but the "fishy" odor is more classically associated with bacterial vaginosis. - Other common symptoms include intense itching, burning, and dyspareunia. *Neisseria gonorrhoeae* - Causes cervicitis, which can lead to a **purulent or mucopurulent vaginal discharge**, but it does not typically produce the distinctive malodor seen in bacterial vaginosis. - Infection can also manifest as dysuria, pelvic pain, or be asymptomatic.

Q: Which of the following conditions can lead to a prolonged second stage of labor?

All of the options. ***All of the options*** - **Uterine inertia**, **maternal exhaustion**, and **cephalopelvic disproportion** are all well-established causes of a prolonged second stage of labor. - These factors either impede effective uterine contractions, reduce the mother's ability to push, or create a physical barrier to fetal descent, respectively. *Uterine inertia* - Refers to **weak** or **ineffective uterine contractions** that are insufficient to expel the fetus. - This directly prolongs the second stage by failing to provide adequate propulsive force. *Maternal exhaustion* - Occurs when the mother becomes too **tired** to effectively push, often due to a long and difficult labor. - Reduced maternal effort leads to a lack of downward pressure, extending the second stage. *Cephalopelvic disproportion* - Characterized by a mismatch between the **size of the fetal head** and the **maternal pelvis**, preventing the head from descending. - This mechanical obstruction inevitably leads to a prolonged, and often ultimately arrested, second stage of labor.

Q: When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?

Forceps may be applied if necessary.. ***Forceps may be applied if necessary.*** - At **station +2**, the fetal head has progressed significantly into the pelvis (2 cm below the ischial spines), indicating a **low-lying head** where instrumental delivery with **forceps** or a **vacuum extractor** can be safely performed if indicated (e.g., maternal exhaustion, fetal distress). - This station qualifies as **low forceps** or **outlet forceps** delivery, which are considered safe procedures when properly indicated. - The fetal head at this level has reached or is approaching the **pelvic floor**, meeting the prerequisites for assisted vaginal delivery. *Crowning occurs at this stage.* - **Crowning** specifically refers to the stage when the largest diameter of the fetal head is visible at the **vaginal introitus** and does not recede between contractions. - This occurs at approximately **station +4 to +5**, not at station +2. - While station +2 indicates significant descent, the fetus must descend further before crowning occurs. *There is a risk of deep transverse arrest.* - **Deep transverse arrest** occurs when the fetal head fails to internally rotate from the transverse position to an occipito-anterior or occipito-posterior position. - This complication typically occurs at **station 0 to +1** (mid-pelvis level), not at station +2. - By the time the fetal head reaches station +2 and the pelvic floor, internal rotation should have already occurred. *Episiotomy must be performed at this station.* - **Episiotomy** is **not mandatory** at any particular fetal station. - It is a selective procedure performed when indicated, typically just before crowning (around station +3 to +4), to prevent severe perineal trauma or expedite delivery. - The decision is based on clinical factors like fetal size, maternal tissue quality, and risk of severe laceration—not solely on fetal station.

Q: What is a common cause of unilateral dysmenorrhea?

One horn of malformed uterus. ***One horn of malformed uterus*** - **Obstructed rudimentary horn** with functional endometrium or **obstructed hemivagina** in uterine anomalies is a **classic cause of unilateral dysmenorrhea**. - The obstruction leads to accumulation of menstrual blood in the non-communicating horn or hemivagina, causing **severe cyclical unilateral pelvic pain** that worsens progressively with each menstrual cycle. - This typically presents in **adolescents or young women** after menarche and is a well-recognized gynecological emergency requiring surgical intervention. - Examples include: **unicornuate uterus with non-communicating rudimentary horn**, **uterus didelphys with obstructed hemivagina** (OHVIRA syndrome). *Endometriosis causing unilateral pain* - While endometriosis causes **dysmenorrhea**, it typically presents with **bilateral pelvic pain** and diffuse tenderness. - Endometriosis pain is usually **generalized** rather than strictly unilateral, though asymmetric involvement can occur. - The pain is associated with **deep dyspareunia**, **dyschezia**, and chronic pelvic pain rather than strictly unilateral cyclical pain. *Small fibroid at the utero tubal junction* - Fibroids (leiomyomas) can cause **dysmenorrhea and menorrhagia**, but unilateral presentation is uncommon. - Cornual fibroids may cause localized pain, but this is not a typical or common presentation of **unilateral dysmenorrhea**. - Pain from fibroids is usually related to **degeneration** or pressure effects rather than cyclical unilateral menstrual pain. *All of the options* - While multiple conditions can cause pelvic pain, **obstructed müllerian anomalies** (one horn of malformed uterus) are the **most classic and important cause** of true unilateral dysmenorrhea. - This is the diagnosis that must be ruled out when a patient presents with unilateral cyclical pelvic pain.

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: Which of the following is a side effect of Progestin Only Pills (POPs)?

Ovarian cysts. ***Ovarian cysts*** - **Functional ovarian cysts** are a known side effect of Progestin Only Pills (**POPs**), as POPs can alter the normal ovulatory cycle but usually do not completely suppress follicular development. - While generally benign and self-resolving, they can cause pain and discomfort. *Venous thromboembolism* - **POPs** are not significantly associated with an increased risk of **venous thromboembolism** due to the absence of estrogen, unlike combined hormonal contraceptives. - This is a key advantage of POPs, making them suitable for individuals at risk for thromboembolic events. *Increased risk of diabetes mellitus* - There is generally **no significant increased risk** of **diabetes mellitus** associated with POPs. - While some hormonal contraceptives *may* have minor effects on glucose metabolism, this is not a prominent or clinically significant side effect of POPs. *Ectopic pregnancy* - POPs **do not increase the risk of ectopic pregnancy**. In fact, they **reduce the overall pregnancy rate**, including ectopic pregnancies, by preventing ovulation. - However, if a pregnancy does occur while on POPs, there is a *slightly higher proportion* of those pregnancies that may be ectopic compared to unaided conceptions, but the *absolute risk* remains low.

Q: What is the primary hormonal cause of hot flushes experienced during menopause?

Decreased estrogen levels. ***Decreased estrogen levels*** - **Decreased estrogen** is the primary hormonal change during menopause, leading to thermoregulatory dysfunction in the hypothalamus. - This hormonal imbalance causes the **vasomotor symptoms** like hot flushes and night sweats. *Increased noradrenaline* - While **noradrenaline** (norepinephrine) is involved in thermoregulation, its increase is a **secondary event** triggered by the initial estrogen deficiency, not the primary cause. - Increased noradrenaline can exacerbate the **vasodilation** and heat dissipation experienced during a hot flush. *Increased noradrenaline with normal estrogen levels* - This option is incorrect because hot flushes are characteristic of menopause, which is defined by **decreased estrogen levels**. - **Normal estrogen levels** would typically prevent the severe thermoregulatory instability that causes hot flushes. *Both increased noradrenaline and decreased estrogen levels* - Although both factors are involved, the question asks for the **primary hormonal cause**. **Decreased estrogen** initiates the cascade of events, including the subsequent alteration of neurotransmitter levels like noradrenaline. - Noradrenaline's role is more of a **mediator** in the physiological response to the primary estrogen deficiency.

Question 1

Which of the following conditions is most commonly associated with malodorous vaginal discharge?

Accepted Answer

Bacterial vaginosis

Answer

Chlamydia trachomatis

Answer

Trichomonas vaginalis

Answer

Neisseria gonorrhoeae

Question 2

Which of the following conditions can lead to a prolonged second stage of labor?

Accepted Answer

All of the options

Answer

Cephalopelvic disproportion

Answer

Uterine inertia

Answer

Maternal exhaustion

Question 3

When the fetus is at station +2 and the fetal skull reaches the pelvic floor, which of the following statements is MOST clinically relevant?

Accepted Answer

Forceps may be applied if necessary.

Answer

Crowning occurs at this stage.

Answer

There is a risk of deep transverse arrest.

Answer

Episiotomy must be performed at this station.

Question 4

What is a common cause of unilateral dysmenorrhea?

Accepted Answer

One horn of malformed uterus

Answer

Small fibroid at the utero tubal junction

Answer

Endometriosis causing unilateral pain

Answer

All of the options

Question 5

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 6

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 7

Which of the following is a side effect of Progestin Only Pills (POPs)?

Accepted Answer

Ovarian cysts

Answer

Venous thromboembolism

Answer

Increased risk of diabetes mellitus

Answer

Ectopic pregnancy

Question 8

What is the most common cause of pelvic inflammatory disease?

Accepted Answer

Chlamydia and gonorrhea infections

Answer

Pelvic peritonitis

Answer

Puerperal sepsis

Answer

Intrauterine Contraceptive Device (IUCD)

Question 9

What is the primary hormonal cause of hot flushes experienced during menopause?

Accepted Answer

Decreased estrogen levels

Answer

Increased noradrenaline with normal estrogen levels

Answer

Increased noradrenaline

Answer

Both increased noradrenaline and decreased estrogen levels

Question 10

All are true about uteroplacental circulation except:

Accepted Answer

A mature placenta has 150 ml of blood in the villi system and 350 ml of blood in the intervillous space

Answer

The villi depend on the maternal blood for their nutrition

Answer

Blood in the intervillous space is completely replaced 3-4 times per minute

Answer

Intervillous blood flow at term is 500-600 ml per minute

NEET-PG 2015 — Obstetrics and Gynecology