NEET-PG 2018 - Obstetrics and Gynecology PYQs Practice Questions

Q: What is the first-line maneuver for management of shoulder dystocia?

Sharp flexion of hip joints towards abdomen. ***Sharp flexion of hip joints towards abdomen*** - This maneuver, known as the **McRoberts maneuver**, widens the anterior-posterior diameter of the **pelvis** and flattens the sacrum. - It increases the likelihood of dislodging the impacted fetal shoulder from behind the symphysis pubis. *Supra pubic pressure* - **Suprapubic pressure** is applied to the fetal anterior shoulder to dislodge it from the symphysis pubis and guide it under the maternal pubic bone. - This maneuver is typically performed *in conjunction with* the McRoberts maneuver, but the question specifies "sharp flexion of hip joints towards abdomen," which is McRoberts alone. *90 degree rotation of posterior shoulder* - This describes the **Woods screw maneuver**, which involves rotating the posterior shoulder to facilitate delivery. It is a secondary maneuver used if McRoberts and suprapubic pressure are insufficient. - The question asks for the primary management step, and the McRoberts maneuver (sharp flexion) is usually the first line of intervention. *Emergency c-section* - An **emergency C-section** is generally not indicated for the acute management of shoulder dystocia once the head has delivered, as it is a **delivery complication** happening during vaginal birth. - Management focuses on specific maneuvers to release the impacted shoulders through the vagina. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What type of uterine anomaly is shown in this X-ray HSG image?

Unicornuate uterus. ***Unicornuate uterus*** - The image shows a single, elongated uterine horn with a single fallopian tube arising from it, consistent with a **unicornuate uterus**. - This congenital anomaly results from the **failure of one Müllerian duct to develop**, leading to an abnormally shaped uterus. *Septate uterus* - A **septate uterus** would show a normal uterine fundus with an internal septum dividing the uterine cavity. - This image clearly depicts only **one rudimentary horn** and no visible septum. *Uterus didelphys* - **Uterus didelphys** involves two completely separate uteri, each with its own cervix and vagina. - The image does not show evidence of a **second, separate uterine structure**. *Bicornuate uterus* - A **bicornuate uterus** is characterized by two distinct uterine horns, which fuse at the cervix or lower uterine segment, creating a heart-shaped appearance of the fundus. - The image shows a **single, long horn** rather than two distinct horns. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Extramammary Paget's disease of the vulva is most commonly associated with which other cancer?

Vulvar cancer. ***Vulvar cancer*** - **Extramammary Paget's disease (EMPD)** frequently presents in the vulvar region and is associated with an underlying **adenocarcinoma** in up to 30% of cases. - The disease involves intraepithelial adenocarcinoma cells that can spread locally and, in some instances, indicates a synchronous or metachronous **internal malignancy**, often of genitourinary or gastrointestinal origin, but primarily vulvar adenocarcinoma in this context. *Vaginal cancer* - While Paget's disease can occur in other anogenital areas, its association with **primary vaginal cancer** is much less common compared to vulvar involvement. - **Vaginal Paget's disease** is rare and usually represents secondary spread from a vulvar primary or an underlying bladder/urethral carcinoma. *Cervical cancer* - **Paget's disease** is not typically associated with **cervical cancer**. Cervical cancers are predominantly squamous cell carcinomas or adenocarcinomas arising from the transformation zone. - While cervical adenocarcinoma can present with similar cells to Paget's, it is a distinct entity and not a common association. *Uterine cancer* - **Uterine cancer**, primarily endometrial carcinoma, has no direct or common association with **Paget's disease**. - Paget's disease primarily affects the skin and can be associated with underlying gland cancers, but these are generally in proximity to the epidermal involvement rather than distant uterine sites. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What are the effects of Progesterone-only pills?

All of the options may occur. ***All of the options may occur*** - Progesterone-only pills (POPs) work through **multiple complementary mechanisms** that collectively provide effective contraception. - All three effects occur simultaneously and contribute to the overall contraceptive efficacy of POPs. - Understanding these mechanisms helps explain why POPs are effective despite lower hormone doses compared to combined oral contraceptives. **Mechanism 1: May suppress ovulation** - POPs can **partially suppress ovulation**, preventing the release of an egg. - Traditional POPs suppress ovulation in approximately 40-60% of cycles, while newer desogestrel-containing POPs achieve higher rates (97-99%). - This effect depends on the dose and type of progestin used in the formulation. **Mechanism 2: Thins the lining of the uterus** - Progesterone causes **endometrial atrophy**, making the uterine lining thin and unsuitable for embryo implantation. - This hostile uterine environment acts as a backup contraceptive mechanism if ovulation and fertilization occur. - Endometrial changes occur consistently with POP use. **Mechanism 3: Thickens cervical mucus** - This is the **primary and most consistent mechanism** of POPs. - Progesterone significantly **increases cervical mucus viscosity** and reduces its quantity within hours of administration. - The thickened mucus creates a physical barrier that prevents sperm penetration, motility, and viability. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which of the following is not a high-risk pregnancy?

Age 25-30 years. ***Age 25-30 years*** - An age of **25-30 years** is generally considered the optimal reproductive age range, and pregnancies within this bracket are typically classified as low-risk based on age alone. - This age range carries the lowest statistical risk for both maternal and fetal complications, assuming no other co-morbidities. *Previous history of manual removal of placenta* - A previous history of manual removal of the placenta indicates a risk factor for **recurrent placental retention** or **morbidly adherent placenta** in future pregnancies, making it a high-risk factor. - This history suggests an increased likelihood of complications such as **postpartum hemorrhage** and can influence the management of subsequent deliveries. *Anemia* - **Anemia** in pregnancy, especially severe iron deficiency anemia, is considered a high-risk factor due to increased maternal and fetal morbidity. - It can lead to complications such as **preterm delivery**, **low birth weight**, and difficulties tolerating blood loss during delivery. *Diabetes mellitus* - **Diabetes mellitus**, whether pre-existing or gestational, makes a pregnancy high-risk due to potential adverse effects on both the mother and the fetus. - Risks include **preeclampsia**, **macrosomia**, **neonatal hypoglycemia**, and **congenital anomalies**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

What is the first-line maneuver for management of shoulder dystocia?

Accepted Answer

Sharp flexion of hip joints towards abdomen

Answer

90 degree rotation of posterior shoulder

Answer

Emergency c-section

Answer

Supra pubic pressure

Question 2

What type of uterine anomaly is shown in this X-ray HSG image?

Accepted Answer

Unicornuate uterus

Answer

Septate uterus

Answer

Uterus didelphys

Answer

Bicornuate uterus

Question 3

Extramammary Paget's disease of the vulva is most commonly associated with which other cancer?

Accepted Answer

Vulvar cancer

Answer

Vaginal cancer

Answer

Cervical cancer

Answer

Uterine cancer

Question 4

What are the effects of Progesterone-only pills?

Accepted Answer

All of the options may occur

Answer

May suppress ovulation

Answer

Thins the lining of the uterus

Answer

Thickens cervical mucus

Question 5

Which of the following is not a high-risk pregnancy?

Accepted Answer

Age 25-30 years

Answer

Diabetes mellitus

Answer

Previous history of manual removal of placenta

Answer

Anemia

Question 6

Which of the following methods is known as a fimbriectomy procedure?

Accepted Answer

Kroener procedure

Answer

Uchida procedure

Answer

Irving procedure

Answer

Madlener procedure

Question 7

What is meant by Superfecundation?

Accepted Answer

Fertilization of two or more ova in different intercourses in same menstrual cycle

Answer

Fertilization of ova and then its division

Answer

Fertilization of two or more ova in one intercourse

Answer

Fertilization of second ovum after first one is already implanted

Question 8

Best time to perform the quadruple test is:

Accepted Answer

15-20 weeks

Answer

8-12 weeks

Answer

11-15 weeks

Answer

18-22 weeks

Question 9

Long-standing pelvic inflammatory disease (PID) may lead to which of the following complications?

Accepted Answer

Hydrosalpinx

Answer

Uterine polyposis

Answer

Endometriosis

Answer

Asherman syndrome

Question 10

Dilatation & curettage (D&C) is contraindicated in-

Accepted Answer

Pelvic inflammatory disease (PID)

Answer

Endometriosis

Answer

Ectopic pregnancy

Answer

Abnormal uterine bleeding

NEET-PG 2018 — Obstetrics and Gynecology