NEET-PG 2015 - Obstetrics and Gynecology Practice Questions

Q: The window of implantation occurs at which of the following time periods after fertilization?

6-10 days. ***6-10 days*** - The uterus is most receptive to implantation during the **"window of implantation,"** which occurs roughly **6 to 10 days post-fertilization**, coinciding with the mid-luteal phase. - During this period, the **endometrial lining** undergoes specific changes, guided by hormonal signals from **progesterone**, making it optimal for the blastocyst to attach. *12 days* - While implantation can still occur, the **peak receptivity window** is generally considered to be narrower, between 6 and 10 days. - By day 12, changes in the **endometrial environment** may start to reduce the likelihood of successful implantation. *12 weeks* - **12 weeks** refer to the end of the first trimester of pregnancy and is far too late for the initial implantation event. - Implantation must have occurred much earlier for a viable pregnancy at this stage. *6 weeks* - **6 weeks** refers to an established pregnancy, at which point implantation would have occurred several weeks prior. - The process of implantation is completed within the first two weeks post-fertilization.

Q: In MRKH syndrome, which of the following structures is typically absent?

Uterus. ***Uterus*** - **Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome** is characterized by congenital aplasia of the **uterus** and upper two-thirds of the vagina. - This is due to abnormal development of the **Müllerian ducts**, which are embryonic structures that form the uterus, fallopian tubes, cervix, and upper vagina. *Breast development* - **Breast development** is typically normal in MRKH syndrome as it is influenced by ovarian hormones, and the **ovaries are usually functional** in these individuals. - Normal breast development indicates that the **estrogen production** from the ovaries is intact. *Pubic hair development* - **Pubic hair development** is also normal in MRKH syndrome, as it is a secondary sexual characteristic driven by **adrenal androgens** and ovarian hormones, which are generally not affected. - The presence of pubic hair indicates **normal adrenal and ovarian androgen production**. *Testes* - **Testes** are male gonads and are therefore not present in individuals with MRKH syndrome, as these patients are **genetically female (46,XX karyotype)**. - The absence of testes is a normal finding in females, and thus not a characteristic feature or absence due to MRKH syndrome itself.

Q: Which of the following describes the points marked in the diagram of pelvic measurements?

Diagonal conjugate. ***Diagonal conjugate*** - The image depicts a **bimanual examination** where one hand is inserted vaginally to measure the distance from the **lower border of the pubic symphysis** to the **sacral promontory**. - This measurement directly corresponds to the **diagonal conjugate**, which is a clinically estimated measurement of the pelvic inlet. *Obstetric conjugate measurement* - The **obstetric conjugate** is the smallest anteroposterior diameter through which the fetal head must pass. - It extends from the **middle of the sacral promontory** to the **innermost aspect of the pubic symphysis** and cannot be measured directly by clinical examination. *True conjugate measurement* - The **true conjugate**, also known as the anatomical conjugate, extends from the **sacral promontory** to the **upper border of the pubic symphysis**. - Like the obstetric conjugate, it is not directly palpable and must be estimated from the diagonal conjugate (true conjugate = diagonal conjugate - 1.5 to 2 cm). *Oblique conjugate measurement* - The **oblique conjugate** measures the distance between the sacroiliac joint on one side to the iliopectineal eminence on the opposite side. - This measurement is not typically assessed during a routine pelvic examination as depicted and is more relevant for identifying asymmetric pelvic deformities.

Q: Which of the following is not considered an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Uterine malformation. ***Uterine malformation*** - While a uterine malformation can make IUD insertion more difficult or reduce its effectiveness, it is often considered a **relative contraindication**, depending on the specific anomaly and the patient's desire for contraception. - In certain cases, an IUD might still be a viable option, but it requires careful consideration and specialized insertion techniques. *Pregnancy* - The presence of an existing pregnancy is an **absolute contraindication** for IUD insertion, as it can lead to complications such as miscarriage or ectopic pregnancy. - An IUD is a contraceptive device, and inserting it when a woman is already pregnant directly contradicts its purpose and poses significant risks. *Undiagnosed vaginal bleeding* - This is an **absolute contraindication** because it could be a symptom of a serious underlying condition, such as cervical cancer, endometrial cancer, or ectopic pregnancy. - Inserting an IUD before diagnosing the cause of the bleeding could delay treatment of a potentially life-threatening condition and exacerbate the bleeding. *Pelvic inflammatory disease* - Current or recent (within the last 3 months) **pelvic inflammatory disease (PID)** is an **absolute contraindication** due to the increased risk of worsening infection. - IUD insertion can introduce bacteria from the vagina into the uterus, potentially exacerbating an existing infection or causing a new one.

Q: Le Fort's operation is done in

Elderly menopausal patients with advanced prolapse. ***Elderly menopausal patients with advanced prolapse*** - Le Fort's operation is a **colpocleisis** procedure, which permanently closes the vagina, making it suitable for elderly patients who are no longer sexually active. - It is often reserved for those with **advanced uterine or vaginal prolapse** who are not candidates for more extensive surgeries due to comorbidities. *Women over 40 years, those who have completed their families* - While these patients may have completed their families, Le Fort's operation is a **definitive and irreversible procedure** that is typically reserved for those who are also postmenopausal and have no desire for future sexual activity. - Other less invasive or reconstructive options might be considered for women over 40 who still maintain sexual activity. *Women under 40 years who are desirous of retaining their menstrual and reproduction function* - Le Fort's operation involves **closure of the vagina**, which makes it impossible to retain menstrual or reproductive function. - Younger women would typically be offered **uterine-sparing procedures** or reconstructive surgeries to preserve these functions. *Young woman suffering from second or third degree prolapse* - For young women, even with significant prolapse, the primary goal is often to **preserve fertility, menstruation, and sexual function**. - Le Fort's operation would be contraindicated because it involves **vaginal obliteration**, making it unsuitable for a young woman.

Question 1

The window of implantation occurs at which of the following time periods after fertilization?

Accepted Answer

6-10 days

Answer

12 days

Answer

12 weeks

Answer

6 weeks

Question 2

In MRKH syndrome, which of the following structures is typically absent?

Accepted Answer

Uterus

Answer

Testes

Answer

Breast development

Answer

Pubic hair development

Question 3

Which of the following describes the points marked in the diagram of pelvic measurements?

Accepted Answer

Diagonal conjugate

Answer

Obstetric conjugate measurement

Answer

True conjugate measurement

Answer

Oblique conjugate measurement

Question 4

Which of the following is not considered an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Accepted Answer

Uterine malformation

Answer

Undiagnosed vaginal bleeding

Answer

Pregnancy

Answer

Pelvic inflammatory disease

Question 5

Le Fort's operation is done in

Accepted Answer

Elderly menopausal patients with advanced prolapse

Answer

Women over 40 years, those who have completed their families

Answer

Women under 40 years who are desirous of retaining their menstrual and reproduction function

Answer

Young woman suffering from second or third degree prolapse

NEET-PG 2015 — Obstetrics and Gynecology