NEET-PG 2024 - Obstetrics and Gynecology PYQs Practice Questions

Q: In the image showing twin pregnancy where fetus A (first twin) is in breech presentation and fetus B (second twin) is in cephalic presentation, what is the recommended method of delivery for fetuses A and B respectively?

LSCS in both. ***LSCS in both*** - When the **first twin (Twin A) is in breech presentation**, current guidelines recommend **cesarean section (LSCS) for BOTH twins** - This avoids significant risks including **head entrapment**, **umbilical cord prolapse**, and **birth trauma** associated with vaginal breech delivery of the first twin - Once a cesarean section is performed for Twin A, delivering Twin B through the same uterine incision is **safer and standard practice** rather than attempting vaginal delivery - **ACOG guidelines** and the **Twin Birth Study (2013)** support cesarean delivery for both twins when Twin A is non-cephalic *LSCS, vaginal* - Delivering Twin A by cesarean section and then attempting **vaginal delivery of Twin B is NOT standard practice** and carries unnecessary risks - After opening the uterus for Twin A, delivering Twin B vaginally would leave an **unsutured uterine incision** with risks of hemorrhage and complications - This mixed approach is **not recommended** in modern obstetric practice *Vaginal, LSCS* - Attempting **vaginal breech delivery for Twin A** is associated with significantly higher risks of fetal morbidity and mortality - The sequence described (vaginal then LSCS) is illogical and not practiced clinically *Induce delivery in both* - **Induction of labor** refers to initiating contractions but does not address the **mode of delivery** (vaginal vs cesarean) - The **presentation of Twin A** is the primary determinant of delivery method, and breech presentation of the first twin is an indication for cesarean delivery regardless of induction [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: The flexion point in ventouse (vacuum) delivery is located at:

3 cm anterior to the posterior fontanelle. ***3 cm anterior to the posterior fontanelle*** - This is the **correct location of the flexion point** (also described as approximately 6 cm posterior to the anterior fontanelle along the sagittal suture). - This position optimizes the **flexion-traction axis** during vacuum extraction, ensuring that the fetal head descends through the birth canal in the most favorable attitude with maximum flexion. - Correct placement of the vacuum cup at this site provides a **mechanical advantage**, leveraging the natural pivot point of the fetal head for effective delivery and bringing the **occiput** down first. *3 cm posterior to the anterior fontanelle* - This location is **too far anterior**, only 3 cm from the anterior fontanelle, and does not correspond to the true flexion point. - Placing the cup here would result in **suboptimal flexion** and poor mechanical advantage during traction. - This may lead to **cup slippage**, increased rate of failed vacuum delivery, and potential scalp injury. *6 cm anterior to the posterior fontanelle* - Since the distance between fontanelles is approximately 9 cm, this position would be equivalent to 3 cm posterior to the anterior fontanelle (too anterior). - This is **not the correct flexion point** and would result in the same problems as placing the cup too far anterior. *Midway between the anterior and posterior fontanelle* - While this location (approximately 4.5 cm from either fontanelle) might seem intuitive, it does not precisely correspond to the optimal **flexion point** for vacuum extraction. - The true flexion point is slightly more posterior, at **3 cm anterior to the posterior fontanelle**, which optimizes the mechanism of labor. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus with abnormal placental attachment to the uterine wall. What is the most likely diagnosis?

Placenta accreta. ***Placenta accreta*** - This diagnosis is strongly suggested by the image showing the **placenta adhered directly to the myometrium**, without invading through the uterine muscular wall. - The history of a **previous cesarean section** is a significant risk factor for placenta accreta, as prior uterine surgery can alter endometrial integrity. *Placenta abruption* - This condition involves the **premature separation of the placenta** from the uterine wall after 20 weeks of gestation but before birth. - It is characterized by symptoms such as **abdominal pain**, **vaginal bleeding**, and **uterine tenderness**, which are not directly depicted by abnormal placental attachment in the image. *Placenta percreta* - This represents the most severe form of abnormal placental adherence, where the **chorionic villi invade through the entire uterine wall** and into adjacent organs like the bladder. - While it shares risk factors with accreta, the image showing attachment "to the uterine wall" rather than invasion *through* it makes percreta less likely. *Placenta previa* - In this condition, the **placenta implants over or near the internal cervical os**, potentially blocking the birth canal. - The image describes abnormal placental attachment *to the uterine wall*, not its position relative to the cervix, differentiating it from placenta previa. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Identify the instrument shown in the image below:

Kielland. ***Kielland*** - Kielland forceps are distinguished by their **lack of pelvic curve** and the presence of a sliding lock mechanism designed for **rotation of the fetal head**. - They are primarily used for **rotational delivery** when the fetal head is in malposition, often in the mid-pelvis. *Simpson* - Simpson forceps have a distinct **cephalic curve** for grasping the fetal head and a **pelvic curve** to conform to the birth canal. - They are commonly used for **outlet and low-cavity deliveries** where minimal rotation is needed. *Wrigley* - Wrigley forceps are a type of **outlet forceps** with a very short shanks and blades, making them suitable only when the fetal head is on the **perineum**. - They are designed for situations where the head is already visible without separating the labia. *Pipers* - Pipers forceps are specifically designed for **delivery of the after-coming head in breech presentations**. - They feature a long, curved shank that allows placement from below the maternal pelvis to grasp the fetal head in this particular presentation. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which of the following is not a contraindication for External Cephalic Version (ECV)?

Primigravida. ***Primigravida*** - Being a **primigravida** (first pregnancy) is not a contraindication for ECV, though it might be associated with a slightly lower success rate compared to multiparous women due to a less pliable uterus. - While it may indicate a potentially more challenging ECV due to higher uterine tone, it does not preclude the procedure if other conditions are favorable. *Placenta previa* - **Placenta previa** is a contraindication because the manipulation of the uterus during ECV could dislodge the placenta, leading to **severe hemorrhage** and potential fetal compromise. - This condition involves the placenta covering the cervical opening, making any uterine intervention risky. *Twin pregnancy* - **Twin pregnancy** is a contraindication as ECV is generally not recommended in multiple gestations due to increased complexity and risk of complications. - The risk of **umbilical cord entanglement**, disruption of twin positioning, and potential harm to either fetus makes ECV unsafe in twin pregnancies. *PROM (Premature Rupture of Membranes)* - **Premature Rupture of Membranes (PROM)** is a contraindication due to the increased risk of uterine infection and **cord prolapse** during manipulation. - Once membranes are ruptured, the natural cushioning provided by the amniotic fluid is lost, making ECV potentially traumatic for both the mother and the fetus. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

In the image showing twin pregnancy where fetus A (first twin) is in breech presentation and fetus B (second twin) is in cephalic presentation, what is the recommended method of delivery for fetuses A and B respectively?

Accepted Answer

LSCS in both

Answer

Vaginal, LSCS

Answer

Induce delivery in both

Answer

LSCS, vaginal

Question 2

The flexion point in ventouse (vacuum) delivery is located at:

Accepted Answer

3 cm anterior to the posterior fontanelle

Answer

3 cm posterior to the anterior fontanelle

Answer

6 cm anterior to the posterior fontanelle

Answer

Midway between the anterior and posterior fontanelle

Question 3

A G2P1L1 woman with a history of previous cesarean section presents with complications related to the placenta. The image below shows the gross appearance of the uterus with abnormal placental attachment to the uterine wall. What is the most likely diagnosis?

Accepted Answer

Placenta accreta

Answer

Placenta abruption

Answer

Placenta percreta

Answer

Placenta previa

Question 4

Identify the instrument shown in the image below:

Accepted Answer

Kielland

Answer

Simpson

Answer

Wrigley

Answer

Pipers

Question 5

Which of the following is not a contraindication for External Cephalic Version (ECV)?

Accepted Answer

Primigravida

Answer

Placenta previa

Answer

Twin pregnancy

Answer

PROM (Premature Rupture of Membranes)

Question 6

A 30-year-old female, G2L2, with a history of cervical elongation presents for surgical consultation. What is the surgery of choice?

Accepted Answer

Fothergill

Answer

McCall

Answer

Lefort

Answer

Hysterectomy

Question 7

A pregnant woman presents with an IUD in place, and the thread is clearly visible. She wishes to continue the pregnancy. What is the most appropriate next step?

Accepted Answer

Remove gently

Answer

Leave the IUD inside

Answer

MTP (Medical Termination of Pregnancy)

Answer

Cesarean section

Question 8

Tubectomy is typically performed on which part of the fallopian tube and why?

Accepted Answer

Isthmus - narrowest

Answer

Ampulla - uniform thickness of muscle

Answer

Ampulla - widest

Answer

Isthmus - uniform thickness of muscle

Question 9

A woman at 30 weeks of gestation is diagnosed with deep vein thrombosis (DVT). Which of the following is the most appropriate treatment for this patient?

Accepted Answer

Low Molecular Weight Heparin (LMWH)

Answer

Warfarin

Answer

Apixaban

Answer

Fondaparinux

Question 10

A patient with eclampsia is being treated with magnesium sulfate. Which of the following is an indication to stop the drug?

Accepted Answer

Urine output less than 100 ml in 4 hours

Answer

Respiratory rate more than 18 per minute

Answer

Exaggerated deep tendon reflexes

Answer

Presence of visual disturbances

NEET-PG 2024 — Obstetrics and Gynecology