NEET-PG 2022 - Obstetrics and Gynecology PYQs Practice Questions

Q: A multigravida at term with a transverse lie and hand prolapse, along with a fetal heart rate of 140/min, is best managed by:

Cesarean delivery. ***Cesarean delivery*** - A **transverse lie** at term is a contraindication to vaginal delivery, as the fetus cannot pass through the birth canal in this orientation. - The presence of **hand prolapse** further complicates the situation, increasing the risk of umbilical cord prolapse and fetal distress, making cesarean section the safest option. *External cephalic version* - This procedure is performed to change a **breech or transverse lie** to a cephalic presentation, but it is typically done *before* term, usually between 36-37 weeks. - It is contraindicated once labor has started or with **membrane rupture** and fetal parts prolapsed, as is implied by hand prolapse in this term patient. *Breech delivery* - Breech delivery involves the fetus presenting buttocks or feet first, which is not the case here; the presentation is **transverse lie** and **hand prolapse**. - While some breech deliveries can be attempted vaginally under specific circumstances, this patient's presentation makes it an inappropriate option. *Internal podalic version* - This procedure involves changing a **transverse lie** to a **breech presentation** by internal manipulation, often performed in cases of twin delivery for the second twin or in specific scenarios of malpresentation in earlier gestations. - It is rarely performed for a single fetus at term due to risks for both mother and fetus, especially with a **term fetus** and **hand prolapse**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: When in labor, a diagnosis of occipito-posterior presentation is made. The most appropriate management would be:

Wait and watch for progress of labor. ***Wait and watch for progress of labor*** - Many **occipito-posterior (OP) presentations** will spontaneously rotate to an occipito-anterior (OA) position with ongoing contractions, especially in multiparous women. - Close monitoring of fetal well-being and labor progress is essential, but immediate intervention is not always required. *Emergency CS* - An emergency cesarean section is typically reserved for cases where there is **fetal distress**, **failure to progress** after a reasonable period of observation, or other clear obstetric indications. - An OP presentation alone, without complications, does not warrant an immediate CS. *Early rupture of membranes* - While sometimes used to evaluate cervical dilation or apply a fetal scalp electrode, **early artificial rupture of membranes (AROM)** in OP presentation is not a definitive management strategy. - It may even increase the risk of cord prolapse or ascending infection without necessarily expediting rotation. *Start oxytocin drip* - **Oxytocin augmentation** may be considered if contractions are inadequate and labor is prolonged, but it's not the first-line management for OP presentation itself. - It should only be initiated after assessing the power, passage, and passenger, and ensuring there are no contraindications to augmentation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: After 3rd stage of labour and expulsion of placenta, the patient is bleeding heavily. Ideal management would include all except:

APGAR scoring. ***APGAR scoring*** - **APGAR scoring** assesses the newborn's health immediately after birth and is not a management step for **postpartum hemorrhage**. - This intervention would divert critical attention from the mother's life-threatening bleeding. *Check for placenta in uterus* - **Retained placental fragments** are a common cause of **postpartum hemorrhage**, obstructing uterine contraction. - Checking for and removing any retained placenta is a crucial and immediate management step to control bleeding. *Check for laceration of labia* - **Lacerations of the birth canal**, including the labia, vagina, or cervix, can cause significant bleeding after delivery, even with a well-contracted uterus. - Identifying and repairing these lacerations is an essential part of managing **postpartum hemorrhage not due to atony**. *Uterine massage and I/V oxytocin* - **Uterine atony** (failure of the uterus to contract) is the most common cause of **postpartum hemorrhage**. - **Uterine massage** helps stimulate contraction, and **intravenous oxytocin** is a uterotonic agent used to promote uterine contraction and reduce bleeding. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 24 year old lactating female with an 18 month old child comes with a history of irregular, heavy bleeding seeking contraceptive advice. Which is the contraceptive of choice?

Progestin-only pill. ***Progestin-only pill*** - The **progestin-only pill (POP)** is the contraceptive of choice for lactating women because it does not affect **breast milk supply** or composition. - It works by thickening cervical mucus and thinning the **endometrium**, which can help reduce heavy bleeding and provide effective contraception. *Copper IUD* - While the **copper IUD** is a highly effective contraceptive, it is known to potentially increase **menstrual bleeding** and cramping. - Given the patient's history of **heavy bleeding**, a copper IUD might worsen her symptoms. *Progestin-only injection* - **Progestin-only injections** like DMPA are highly effective and safe for lactating women, but they can cause **irregular bleeding patterns** initially and are associated with a slower return to fertility. - While an option, the **progestin-only pill** offers more immediate control over menstrual patterns and easier discontinuation if side effects are problematic. *Combined oral contraceptive pill* - **Combined oral contraceptive pills (COCs)** contain both estrogen and progestin. Estrogen can negatively impact **milk production** and may not be suitable for breastfeeding mothers, especially in the first 6 months postpartum. - COCs are generally avoided in lactating women until breastfeeding is well-established or after 6 months to prevent interference with **lactation**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

A multigravida at term with a transverse lie and hand prolapse, along with a fetal heart rate of 140/min, is best managed by:

Accepted Answer

Cesarean delivery

Answer

External cephalic version

Answer

Breech delivery

Answer

Internal podalic version

Question 2

When in labor, a diagnosis of occipito-posterior presentation is made. The most appropriate management would be:

Accepted Answer

Wait and watch for progress of labor

Answer

Emergency CS

Answer

Early rupture of membranes

Answer

Start oxytocin drip

Question 3

After 3rd stage of labour and expulsion of placenta, the patient is bleeding heavily. Ideal management would include all except:

Accepted Answer

APGAR scoring

Answer

Check for laceration of labia

Answer

Uterine massage and I/V oxytocin

Answer

Check for placenta in uterus

Question 4

A primigravida presents to the labor room at 40 weeks of gestation with lower abdominal pain.    She has been in labor for 3 hours. Which of the following will determine if she is in active    labor?

Accepted Answer

Cervical dilatation of 6 cm or more with regular contractions

Answer

Fetal head 5/5 palpable on abdominal examination

Answer

Two contractions lasting for 10 seconds in 10 minutes

Answer

Rupture of membranes

Question 5

A 24 year old lactating female with an 18 month old child comes with a history of irregular,    heavy bleeding seeking contraceptive advice. Which is the contraceptive of choice?

Accepted Answer

Progestin-only pill

Answer

Copper IUD

Answer

Progestin-only injection

Answer

Combined oral contraceptive pill

Question 6

A 20 year old woman presented at 7 weeks of gestation, unwilling to continue the pregnancy.    What are the drugs used for medical termination of pregnancy in this patient?

Accepted Answer

Misoprostol and Mifepristone

Answer

Misoprostol and Medroxyprogesterone

Answer

Mifepristone and Medroxyprogesterone

Answer

Mifepristone and Methotrexate

Question 7

What will be the level of the uterus on the second day post delivery?

Accepted Answer

One finger breadth below umbilicus

Answer

Two finger breadths below umbilicus

Answer

Three finger breadths below umbilicus

Answer

Four finger breadths below umbilicus

Question 8

A 20 year old woman is evaluated for primary infertility. Hysterosalpingography was done and reveals an anomaly. What is the anomaly seen in the image?

Accepted Answer

Septate uterus

Answer

Uterine didelphys

Answer

Bicornuate uterus

Answer

Unicornuate uterus

Question 9

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

Accepted Answer

Uterine malformation

Answer

Pregnancy

Answer

Active pelvic infection

Answer

Known allergy to IUD components

Question 10

A primigravida at 22 weeks of gestation presents with profuse vaginal bleeding. Her blood pressure and glucose levels are normal. At which of the following sites can placental implantation lead to this condition?

Accepted Answer

Over the internal cervical os

Answer

In the fallopian tube

Answer

On the ovary

Answer

In the abdominal cavity

NEET-PG 2022 — Obstetrics and Gynecology