NEET-PG 2017 - Obstetrics and Gynecology PYQs Practice Questions

Q: A pregnant woman undergoes a routine antenatal ultrasound scan in the second trimester. The sonologist notes an abnormal appearance of the fetal skull. What is the sign demonstrated in the given antenatal USG image?

Lemon sign. ***Lemon sign*** - The **lemon sign** refers to the shape of the fetal skull on ultrasound, where the frontal bones are indented, making the head appear lemon-shaped. - This sign is often associated with **Chiari II malformation** and spina bifida, where there is downward displacement of the cerebellar vermis and fourth ventricle. *Boomerang sign* - The **boomerang sign** is typically observed in imaging of the knee, referring to a meniscal tear where the displaced fragment resembles a boomerang. - It is not a sign used for fetal cranial abnormalities in ultrasound. *Spring coiled sign* - The **spring coiled sign** is a feature seen in intussusception on ultrasound, where layers of bowel are invaginated within another, resembling a coiled spring. - This sign is related to intestinal pathology, not fetal head anomalies. *Banana sign* - The **banana sign** describes the appearance of the cerebellum on fetal ultrasound when it is displaced or compressed due to Chiari II malformation, making it appear banana-shaped. - While also associated with Chiari II, the image provided shows the **head shape**, not the cerebellum, aligning with the lemon sign. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Transvaginal saline infusion sonographic evaluation shows:

Asherman's syndrome. ***Asherman's syndrome*** - The image shows **intracavitary adhesions** within the endometrial cavity, characterized by bridging bands or strands of tissue with an irregular endometrial surface, as indicated by the arrow. - These findings on **saline infusion sonography (SIS)** are highly suggestive of **Asherman's syndrome**, which involves the formation of intrauterine adhesions. *Submucous leiomyoma* - Submucous leiomyomas (submucosal fibroids) are fibroids that project into the endometrial cavity and typically appear as **well-defined, hypoechoic masses** that distort the cavity. - The image does not show a distinct mass but rather **irregular strands** and a distorted cavity indicative of adhesions, not a fibroid. *Cervical stenosis* - Cervical stenosis involves an **abnormal narrowing of the cervical canal**, which would be seen as an obstruction to fluid flow into the uterine cavity during SIS. - While the image shows fluid within the uterine cavity, the primary pathology is within the cavity itself, not merely an obstruction at the cervix. *PCOD* - **Polycystic ovary syndrome (PCOS)** is primarily an ovarian disorder characterized by **multiple small follicles** (cysts) in the ovaries and hormonal imbalances. - PCOS is not a condition diagnosed by evaluating the endometrial cavity for adhesions using saline infusion sonography. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What is the best treatment for the condition shown below?

Hysteroscopic adhesiolysis. ***Hysteroscopic adhesiolysis*** - The image shows an **intrauterine synechia**, also known as an **Asherman syndrome** or uterine adhesion, which manifests as fibrous bands within the uterine cavity (indicated by the arrow). - **Hysteroscopic adhesiolysis** is the gold standard for treating intrauterine adhesions, involving the surgical removal of these adhesions under direct visualization to restore the uterine cavity's normal anatomy. *OCP* - **Oral contraceptive pills (OCPs)** are primarily used for contraception, managing menstrual irregularities, or hormonal therapy. - They do not address or resolve **intrauterine adhesions** causing conditions like Asherman syndrome. *Transvaginal hysterectomy* - A **transvaginal hysterectomy** involves the surgical removal of the entire uterus, which is an aggressive and irreversible procedure. - This is not an appropriate treatment for intrauterine adhesions, especially in patients who may desire future fertility. *Intrauterine hyaluronidase injection* - While hyaluronidase is an enzyme that breaks down hyaluronic acid and has been explored in various applications, its efficacy as a primary treatment for established **intrauterine adhesions** is not well-supported in clinical practice. - The **mechanical removal** of fibrous adhesions is typically required. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 25-year-old lady had tubal rupture due to ectopic pregnancy at 6 weeks. The most common site of rupture of ectopic pregnancy amongst the following is:

2. ***Option 2 (Ampulla)*** - The image shows the **ampulla** of the fallopian tube labeled with '2'. This is the **most common site** for ectopic pregnancies, accounting for approximately **80-90%** of all tubal ectopic pregnancies. - The ampulla is the widest and longest part of the fallopian tube, making it a frequent location for implantation outside the uterus. Despite being wider, rupture is common here due to the thin wall and progressive distension from the growing pregnancy. *Option 1 (Interstitial/Cornual)* - The image points to the **interstitial** (or cornual) portion of the fallopian tube, labeled '1'. This is the **least common site** for ectopic pregnancy, accounting for only **2-4%** of cases. - While rare, rupture here can be **catastrophic** due to proximity to the uterine blood supply and rich vascular anastomoses, leading to severe hemorrhage. *Option 3 (Isthmus)* - The image highlights the **isthmus** of the fallopian tube with '3'. Ectopic pregnancies in the isthmus account for approximately **12%** of cases. - Rupture in the isthmus typically occurs **earlier** (around 6-8 weeks) than in the ampulla due to its narrower lumen and thicker muscular wall, which limits its ability to accommodate the growing pregnancy. *Option 4 (Infundibulum/Fimbriae)* - The image points to the **infundibulum** and **fimbriae**, labeled '4'. Fimbrial ectopic pregnancies are **extremely rare**, accounting for less than **5%** of cases. - The fimbriae are involved in capturing the ovum after ovulation. Implantation here is uncommon and may result in fimbrial abortion rather than rupture. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: The image shows:

PUBS. **PUBS** - The image displays a procedure where a needle is inserted through the maternal abdomen and into the **umbilical cord blood vessel** of the fetus, which is characteristic of **Percutaneous Umbilical Blood Sampling (PUBS)**. - PUBS, also known as **cordocentesis**, is used to obtain fetal blood for diagnostic purposes, such as detecting chromosomal abnormalities, genetic disorders, or fetal infections. *Amniocentesis* - **Amniocentesis** involves sampling **amniotic fluid** from the sac surrounding the fetus, not directly from the umbilical cord. - The needle in amniocentesis typically targets the amniotic sac, while in the image, it clearly targets an umbilical vessel. *Chorionic villus sampling* - **Chorionic villus sampling (CVS)** involves obtaining tissue from the **placenta** (chorionic villi), either transabdominally or transcervically. - The image clearly shows the needle entering the umbilical cord, not the placental tissue. *Fetal scalp sampling* - **Fetal scalp sampling** is performed during labor to assess fetal well-being by analyzing **fetal blood pH** from a small incision on the fetal scalp. - This procedure is performed late in pregnancy during labor and involves accessing the fetal scalp via the cervix, which is distinct from the transabdominal umbilical cord access shown. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

A pregnant woman undergoes a routine antenatal ultrasound scan in the second trimester. The sonologist notes an abnormal appearance of the fetal skull. What is the sign demonstrated in the given antenatal USG image?

Accepted Answer

Lemon sign

Answer

Boomerang sign

Answer

Spring coiled sign

Answer

Banana sign

Question 2

Transvaginal saline infusion sonographic evaluation shows:

Accepted Answer

Asherman's syndrome

Answer

Submucous leiomyoma

Answer

Cervical stenosis

Answer

PCOD

Question 3

What is the best treatment for the condition shown below?

Accepted Answer

Hysteroscopic adhesiolysis

Answer

OCP

Answer

Transvaginal hysterectomy

Answer

Intrauterine hyaluronidase injection

Question 4

A 25-year-old lady had tubal rupture due to ectopic pregnancy at 6 weeks. The most common site of rupture of ectopic pregnancy amongst the following is:

Accepted Answer

2

Answer

1

Answer

3

Answer

4

Question 5

The image shows:

Accepted Answer

PUBS

Answer

Amniocentesis

Answer

Chorionic villus sampling

Answer

Fetal scalp sampling

Question 6

Which is incorrect about the presentation shown below?

Accepted Answer

Mark commonly seen with platypelloid pelvis

Answer

Associated with anencephaly

Answer

Head is partially extended

Answer

Vaginal delivery is possible

Question 7

Which is the least common type of pelvis out of the types shown below?

Accepted Answer

3

Answer

1

Answer

2

Answer

4

Question 8

Which of the following is correct about the placenta shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

Battledore placenta

Answer

Velamentous cord insertion

Answer

Placental chorioangioma

Answer

Circumvallate placenta

Question 9

What is the type of placenta previa shown below?

Accepted Answer

Type 4

Answer

Type 1

Answer

Type 2

Answer

Type 3

Question 10

The image shows:

Accepted Answer

Rachitic pelvis

Answer

Scoliotic pelvis

Answer

Osteomalacic pelvis

Answer

Naegele pelvis

NEET-PG 2017 — Obstetrics and Gynecology