NEET-PG 2015 - Obstetrics and Gynecology Practice Questions

Q: What is the recommended management for a patient with complete placenta previa at 38 weeks gestation without any vaginal bleeding?

Elective caesarean section. ***Elective caesarean section*** - For women with **complete placenta previa** at term (38 weeks), an **elective caesarean section** is the recommended mode of delivery to avoid significant hemorrhage. - Even in the absence of bleeding, the risk of massive hemorrhage during labor with a complete previa is high, necessitating planned surgical delivery. *Observation and monitoring until delivery* - This approach is not safe for complete placenta previa at term due to the high risk of **unpredictable, severe hemorrhage** once labor begins or the cervix dilates. - Active monitoring without planned intervention carries significant maternal and fetal risk. *Conservative management with bed rest* - While bed rest may be used in cases of **placenta previa with bleeding** earlier in gestation to prolong pregnancy, it does not address the fundamental risk of hemorrhage from a complete previa at 38 weeks. - It would not prevent the need for an eventual caesarean section and prolongs potential risks. *Urgent caesarean section due to bleeding risk* - While there is a bleeding risk, this scenario describes a patient at 38 weeks gestation **without any vaginal bleeding**, making it an elective, rather than urgent, situation. - An **urgent caesarean section** is typically reserved for cases where active bleeding or other obstetric emergencies are present.

Q: Which of the following is the PRIMARY risk factor for cervical carcinoma?

Human papilloma virus. ***Human papilloma virus*** - **High-risk HPV types**, particularly **HPV 16 and 18**, are the primary causative agent of cervical carcinoma, responsible for over 90% of cases. - HPV infection is the **most significant and essential risk factor**, leading to persistent changes in cervical cells that can progress to **dysplasia** and eventually **invasive cancer**. - Cervical cancer is considered an **HPV-associated malignancy**, making HPV the central etiological factor. *Smoking* - **Smoking** is an important cofactor that increases the risk of cervical carcinoma in women with HPV infection, but it is not the primary cause. - Smoking impairs the immune system's ability to clear HPV infections and promotes progression of HPV-induced lesions. - Without HPV infection, smoking alone does not cause cervical cancer. *Low socioeconomic status* - **Low socioeconomic status** is an indirect risk factor associated with reduced access to healthcare and **cervical cancer screening** (Pap smears). - It does not directly cause cervical cancer but leads to delayed diagnosis and treatment, resulting in poorer outcomes. *All of the options* - While all listed factors influence cervical carcinoma risk, **Human papillomavirus (HPV)** is the primary and essential causative agent. - The other factors are cofactors or indirect associations, not primary causes.

Q: What is the most common cause of death in cervical cancer?

Renal failure. ***Renal failure*** - As cervical cancer progresses, it can invade surrounding structures, including the **ureters**. - **Ureteral obstruction** leads to **hydronephrosis** and ultimately **renal failure**, which is a common cause of death. *Infection* - While infections can occur due to immunosuppression or compromised tissue integrity in advanced cancer, they are generally **not the most common direct cause of death**. - Infections are often secondary complications rather than the primary mode of mortality. *Haemorrhage* - Local invasion of blood vessels by advanced cervical cancer can cause **significant bleeding** (haemorrhage). - While potentially life-threatening, it is **less frequent** as a direct cause of death compared to renal failure. *Metastasis to vital organs* - Cervical cancer can metastasize to distant organs like the lungs, liver, or bone; however, direct organ failure solely due to metastases is **less common than renal complications** from local tumor spread. - The impact of metastases often contributes to overall decline but is not the most frequent immediate cause of death.

Q: Which of the following is not a standard treatment option for CIN III?

Wertheim's hysterectomy. ***Wertheim's hysterectomy*** - A **Wertheim's hysterectomy**, also known as a **radical hysterectomy**, involves removal of the uterus, cervix, parametrium, and upper vagina, along with pelvic lymph node dissection. This is typically reserved for **invasive cervical cancer**, not CIN III. - While hysterectomy can be a treatment option for CIN III in specific circumstances (e.g., patient preference, coexisting uterine pathology), a Wertheim's hysterectomy is an **overly aggressive procedure** for precancerous lesions due to its significant morbidity. *LLETZ* - **Large Loop Excision of the Transformation Zone (LLETZ)**, also known as LEEP (Loop Electrosurgical Excision Procedure), is a common and effective outpatient treatment for CIN III. - It involves using a heated wire loop to **excise the abnormal tissue** from the cervix, allowing for histological examination. *Conization* - **Cold knife conization** involves excising a cone-shaped piece of tissue from the cervix using a scalpel. This method is highly effective for CIN III. - It provides **excellent pathological specimens** for evaluation of margins, which is crucial for confirming complete removal of the lesion. *Hysterectomy* - **Hysterectomy** (removal of the uterus, usually simple hysterectomy) can be considered a treatment option for CIN III, particularly in women who have completed childbearing and have other indications for hysterectomy, or when repeated excisional procedures have failed. - While effective, it is a more **invasive procedure** than LLETZ or conization and generally reserved for specific cases where conservative management is not suitable or desired.

Q: What size of Hegar's dilator, when passed through the internal os, indicates cervical incompetence?

8 or more. ***8 or more*** - The passage of a **Hegar's dilator of size 8 mm or larger** through the internal os without resistance is a classic diagnostic criterion for **cervical incompetence** or insufficiency. - This finding suggests a **weakened cervix** that is unable to withstand the pressure of a growing pregnancy, leading to recurrent mid-trimester pregnancy losses or preterm births. *4* - A Hegar's dilator of size 4 mm is relatively small and can often pass through a normal, non-pregnant **cervical os** without indicating pathology. - This size would not be considered abnormal and does not signify **cervical incompetence**. *6* - While a Hegar's dilator of 6 mm is larger than 4 mm, it is still generally within the range that might pass through a normal cervix, especially in **multiparous women**, without definitively diagnosing incompetence. - The threshold for diagnosing **cervical incompetence** is typically set higher, at 8 mm or more. *10* - While the passage of a 10 mm Hegar's dilator would certainly indicate **cervical incompetence**, the diagnostic cutoff is typically considered to be **8 mm or more**. - Any dilator **equal to or greater than 8 mm** confirms the diagnosis, so 10 mm is not the *only* size indicating incompetence.

Q: Funneling in cervicogram is seen in -

Weak cervical tissue leading to pregnancy complications. ***Weak cervical tissue leading to pregnancy complications*** - **Funneling** in a cervicogram (or during transvaginal ultrasound) indicates the shortening and dilation of the internal cervical os, forming a funnel shape. - This finding is a key indicator of **cervical insufficiency** or **weak cervical tissue**, which significantly increases the risk of preterm birth and other pregnancy complications due to the inability of the cervix to retain the pregnancy. *During labor* - While the cervix dilates and effaces during labor, the term "funneling" specifically refers to the premature opening of the internal os seen *before* active labor, often indicative of **cervical insufficiency**. - During active labor, the entire cervix generally dilates progressively, rather than forming a distinct funnel shape. *Cervical ectopic* - A **cervical ectopic pregnancy** involves the implantation of a fertilized egg within the cervical canal. - While it affects the cervix, the defining characteristic is the presence of an implanted gestational sac, not specifically cervical funneling. *During TVS* - **Transvaginal ultrasound (TVS)** is the primary method used to assess cervical length and detect funneling. - Funneling itself is a sign of cervical changes, observed *via* TVS, rather than TVS *causing* or *being* the funneling.

Q: Contracted pelvis is defined as a condition where the dimensions of the pelvis are reduced, making childbirth difficult. What is the minimum shortening of one or more planes that is considered significant?

1.5 cm. ***1.5 cm*** - A reduction of **1.5 cm or more** in any of the pelvic planes is widely accepted as **clinically significant** to define a contracted pelvis. - Most standard obstetric textbooks (including Williams Obstetrics and DC Dutta) cite **1.5-2 cm** as the threshold for clinically significant pelvic contraction. - This degree of shortening can impede the normal mechanism of labor and increase the risk of **cephalopelvic disproportion**. *1 cm* - While some older references mention 1 cm, the **generally accepted minimum threshold** in modern obstetric practice is **1.5-2 cm**. - A reduction of only 1 cm may not consistently cause significant obstetric complications and falls within the range of normal variation in many cases. *1.25 cm* - This value is **below the standard threshold** of 1.5-2 cm used to define a contracted pelvis in most authoritative obstetric texts. - While it represents some reduction, it does not meet the minimum accepted criterion for clinical significance. *0.5 cm* - A shortening of **0.5 cm** is **insufficient** to classify a pelvis as contracted. - Minor variations within this range fall within the **normal spectrum** and do not typically cause labor complications.

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.

Question 1

What is the recommended management for a patient with complete placenta previa at 38 weeks gestation without any vaginal bleeding?

Accepted Answer

Elective caesarean section

Answer

Observation and monitoring until delivery

Answer

Conservative management with bed rest

Answer

Urgent caesarean section due to bleeding risk

Question 2

Which of the following statements about nabothian cysts is true?

Accepted Answer

Squamous epithelium grows over columnar epithelium, blocking mucus-secreting glands.

Answer

It is a premalignant condition that requires excision.

Answer

It is a malignant condition.

Answer

It may be associated with chronic irritation and inflammation but is not defined by it.

Question 3

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 4

Which of the following is the PRIMARY risk factor for cervical carcinoma?

Accepted Answer

Human papilloma virus

Answer

Smoking

Answer

Low socioeconomic status

Answer

All of the options

Question 5

What is the most common cause of death in cervical cancer?

Accepted Answer

Renal failure

Answer

Infection

Answer

Haemorrhage

Answer

Metastasis to vital organs

Question 6

Which of the following is not a standard treatment option for CIN III?

Accepted Answer

Wertheim's hysterectomy

Answer

LLETZ

Answer

Conization

Answer

Hysterectomy

Question 7

What size of Hegar's dilator, when passed through the internal os, indicates cervical incompetence?

Accepted Answer

8 or more

Answer

4

Answer

6

Answer

10

Question 8

Funneling in cervicogram is seen in -

Accepted Answer

Weak cervical tissue leading to pregnancy complications

Answer

Cervical ectopic

Answer

During TVS

Answer

During labor

Question 9

Contracted pelvis is defined as a condition where the dimensions of the pelvis are reduced, making childbirth difficult. What is the minimum shortening of one or more planes that is considered significant?

Accepted Answer

1.5 cm

Answer

0.5 cm

Answer

1.25 cm

Answer

1 cm

Question 10

What is the most common type of conjoint twin?

Accepted Answer

Thoracopagus

Answer

Omphalopagus

Answer

Craniopagus

Answer

Rachipagus

NEET-PG 2015 — Obstetrics and Gynecology