NEET-PG 2013 - Obstetrics and Gynecology Practice Questions

Q: What percentage of women typically deliver on their Estimated Due Date (EDD)?

5%. ***5%*** - Only about **5% of women** deliver on their **exact Estimated Due Date (EDD)**. - The EDD is calculated using **Naegele's rule** (280 days from LMP) and serves as an **approximation** rather than a precise prediction. - Most women deliver within a **37-42 week window**, with the majority occurring in the **2 weeks before or after** the EDD. - This reflects the **natural biological variation** in pregnancy duration. *10%* - This percentage is **higher than the actual rate** of delivery on the exact EDD. - While 10% might seem plausible for deliveries within a few days of the EDD, it overestimates delivery on that specific date. *15%* - This percentage **significantly overestimates** the likelihood of delivering precisely on the EDD. - The probability of birth on one specific day out of a several-week delivery window is relatively low. *20%* - This is a substantial **overestimation** of the probability of delivering on the EDD. - The EDD represents a **single day** in a term pregnancy window (37-42 weeks), making such a high percentage statistically unlikely.

Q: What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?

Within 3 weeks. **Correct Answer: Within 3 weeks** - The highest risk of **Pelvic Inflammatory Disease (PID)** after IUD insertion is typically observed in the **first 20 days (approximately 3 weeks)** post-insertion. - This elevated risk is mainly due to the potential introduction of **bacteria** from the vagina or cervix into the uterus during the insertion process. - Studies show that the risk of PID is **6-fold higher** in the first 20 days compared to later periods. *Incorrect: Within 5 weeks* - While PID can occur after 3 weeks, the **highest incidence** is concentrated in the earlier period (first 3 weeks). - The risk significantly **decreases after the initial weeks**, suggesting that the critical window for bacterial ascent is shorter. *Incorrect: Within 7 weeks* - By 7 weeks, the risk of developing PID attributable to IUD insertion becomes **negligible** compared to the general population. - Most infections that manifest beyond the initial month are usually due to **newly acquired sexually transmitted infections (STIs)**, not the insertion itself. *Incorrect: Within 14 weeks* - At 14 weeks, any PID development is generally **not linked to the IUD insertion event** but rather to other risk factors like new sexual partners or untreated STIs. - The immediate trauma and potential bacterial contamination from the insertion procedure have **long ceased to be the primary cause** of infection.

Q: In which obstetric condition is assisted head delivery typically performed?

Breech presentation. ***Breech presentation*** - In a **breech presentation**, the baby's buttocks or feet are delivered first, necessitating assisted head delivery to prevent **head entrapment** in the maternal pelvis, which can lead to fetal hypoxia or trauma. - Techniques like the **Mauriceau-Smellie-Veit maneuver** are employed to carefully deliver the fetal head after the body. *Shoulder dystocia* - This condition involves the impaction of the fetal shoulder against the maternal symphysis pubis after the head has been delivered. - The focus of management is on delivering the shoulders, not the head, through maneuvers such as the **McRoberts maneuver** or **suprapubic pressure**. *Transverse lie* - A **transverse lie** means the baby is positioned horizontally across the uterus, preventing vaginal delivery without intervention (e.g., external cephalic version or C-section). - This position requires repositioning or surgical delivery of the entire fetus, and assisted head delivery is not the primary concern. *Normal delivery* - In a **normal (vertex) delivery**, the fetal head presents first and typically delivers spontaneously with minimal assistance. - The head usually flexes and rotates to navigate the birth canal on its own, so specific assisted head delivery techniques are not typically required.

Q: What is Hegar's sign in obstetrics?

Softening of the uterine isthmus. ***Softening of the uterine isthmus*** - **Hegar's sign** is an early presumptive sign of pregnancy characterized by the **softening of the lower uterine segment (isthmus)**, which can be palpated during a bimanual examination. - This softening makes the fundus and cervix feel like separate entities, indicating increased vascularity and changes due to hormonal influence. *Uterine contractions* - While contractions do occur during pregnancy (e.g., **Braxton Hicks contractions**), they are not what defines Hegar's sign. - **Uterine contractions** are typically associated with labor or placental abruption, not the specific softening of the isthmus. *Fetal movement* - **Fetal movement** (quickening) is a positive sign of pregnancy perceived by the mother, usually after 16-20 weeks gestation. - This is entirely distinct from Hegar's sign, which is a physical finding upon examination of the uterus. *Cyanosis of the vagina* - **Cyanosis of the vagina** and cervix is known as **Chadwick's sign**, another presumptive sign of pregnancy. - Chadwick's sign is due to increased vascularity and venous congestion, causing a bluish discoloration, but it's not the softening described in Hegar's sign.

Q: Bishop scoring is done for ?

Induction of labor assessment. ***Induction of labor assessment*** - The **Bishop score** is a pre-labor scoring system used to assess the ripeness of the cervix. - A higher score indicates a more **favorable cervix** for the successful **induction of labor**. *Exchange transfusion in newborns* - **Exchange transfusion** is primarily indicated for severe hyperbilirubinemia or hemolytic disease in newborns. - Its assessment is based on **bilirubin levels** and other clinical factors, not the Bishop score. *Newborn ventilation assessment* - **Newborn ventilation assessment** involves evaluating respiratory effort, heart rate, and oxygenation status, often using scores like the **Apgar score**. - The Bishop score is unrelated to neonatal respiratory function. *Newborn gestation assessment* - **Newborn gestation assessment** is typically performed using methods like the **New Ballard Score** or by reviewing prenatal ultrasound dating. - The Bishop score is used in *maternal* obstetric management, not directly for neonatal gestational age estimation.

Q: Which of the following is the most common genital infection in pregnancy?

Vaginal candidiasis. ***Vaginal candidiasis*** - **Vaginal candidiasis**, commonly known as a yeast infection, is the **most frequent genital infection** during pregnancy due to hormonal changes that alter the vaginal microenvironment. - Pregnancy increases susceptibility through **elevated estrogen levels**, **increased vaginal glycogen**, and **altered vaginal pH**. - While generally not harmful to the fetus, it can cause significant maternal discomfort with symptoms like **itching**, burning, and a **thick, white, cottage cheese-like discharge**. *Gonorrhea* - Gonorrhea is a **sexually transmitted infection (STI)** that, although possible, is not the most common genital infection in pregnancy. - It carries a risk of serious complications for both mother and infant, including **preterm birth**, **chorioamnionitis**, and **neonatal conjunctivitis** (ophthalmia neonatorum). *Chlamydia* - Chlamydia is another **STI** that can occur during pregnancy but is not as common as candidiasis. - Untreated chlamydia can lead to **preterm rupture of membranes**, **preterm labor**, and **postpartum endometritis** in the mother, and **conjunctivitis** or **pneumonia** in the newborn. *Bacterial vaginosis* - Bacterial vaginosis (BV) is a common vaginal infection caused by an **imbalance in normal vaginal flora**, with overgrowth of anaerobic bacteria. - While BV is the most common vaginal infection in **non-pregnant women**, vaginal candidiasis is more frequently encountered during pregnancy due to hormonal changes. - BV in pregnancy is associated with increased risk of **preterm birth**, **preterm rupture of membranes**, and **postpartum endometritis**, making screening and treatment important.

Q: A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?

Stage 3C. ***Stage 3C*** - **Bilateral ovarian carcinoma** with **capsule involvement**, **ascites**, and especially **paraaortic lymph node metastases** are defining features of Stage IIIC ovarian cancer. - Involvement of **retroperitoneal lymph nodes**, including paraaortic nodes, automatically upstages the disease to Stage III, irrespective of other abdominal spread. *Stage 1C* - This stage refers to ovarian cancer confined to **one or both ovaries**, with evidence of rupture, capsule involvement, or malignant cells in ascites/peritoneal washings, but **without lymph node involvement**. - The presence of **paraaortic lymphadenopathy** in this patient immediately excludes Stage 1C. *Stage 2C* - Stage 2 ovarian cancer involves one or both ovaries with **pelvic extension** beyond the ovaries, but still **without lymph node involvement**. - The patient's involvement of **paraaortic lymph nodes** goes beyond pelvic extension and therefore excludes Stage 2C. *Stage 4C* - Stage 4 ovarian carcinoma involves **distant metastasis** beyond the peritoneal cavity or distant lymph nodes (e.g., pleural effusion with positive cytology, parenchymal liver/spleen metastasis). - While paraaortic lymphadenopathy indicates advanced disease, it falls within the criteria for Stage 3 due to its location, not Stage 4.

Q: Commonest variety of compound presentation is?

Head with hand. ***Head with hand*** - This is the **most frequent type** of compound presentation, where a fetal extremity (typically a hand) prolapses alongside the fetal head into the maternal pelvis. - It occurs due to factors that prevent the fetal head from snugly filling the pelvis, such as **cephalopelvic disproportion** or a **high fetal station**. *Head with foot* - While possible, the presentation of the **head with a foot** is less common than with a hand. - A foot alongside the head often suggests a more complex presentation or potential issues with fetal lie or attitude. *Head with both foot* - The simultaneous presentation of the **head with both feet** is exceedingly rare. - This scenario would indicate a profound degree of space for fetal extremities to descend alongside the head, possibly in cases of extreme prematurity or pelvic relaxation. *Head, hand & foot* - The combined presentation of the **head, a hand, and a foot** is extremely uncommon. - Such a complex presentation would suggest significant fetal mobility in a large pelvic space, making it a very rare occurrence in clinical practice.

Q: Which of the following statements about radical hysterectomy in stage Ib cervical cancer compared to radiotherapy is false?

It is less complicated than radiotherapy.. ***It is less complicated than radiotherapy.*** - Radical hysterectomy is a **major surgical procedure** with potential complications like **hemorrhage**, infection, **ureteral injury**, and **lymphedema**, which can be significant and life-altering. - Radiotherapy, while having its own set of side effects (e.g., **vaginal stenosis**, bladder/rectal irritation), typically avoids the acute surgical risks and recovery period associated with extensive surgery. *Chance of recurrence is lower with radical hysterectomy.* - For early-stage cervical cancer (Ib1/Ib2), both **radical hysterectomy** and **radiotherapy** provide **comparable outcomes** in terms of recurrence rates. - The choice between therapies often depends on patient factors, surgeon expertise, and pathological findings, but neither consistently demonstrates a significantly lower recurrence rate over the other in large cohorts. *Ovarian function can be preserved.* - In younger patients undergoing **radical hysterectomy**, it is often possible to **preserve the ovaries** by transplanting them or avoiding their removal if not directly involved, thus maintaining **endocrine function**. - **Pelvic radiotherapy**, in contrast, invariably leads to **ovarian radiation** and subsequent **ovarian failure** and menopause. *Chance of survival is higher with radical hysterectomy.* - For early-stage cervical cancer (Ib), **overall survival rates** are generally **equivalent** between radical hysterectomy and primary radiotherapy. - Meta-analyses and large retrospective studies have shown **similar 5-year survival rates** for both treatment modalities when applied appropriately to well-selected patients.

Question 1

What percentage of women typically deliver on their Estimated Due Date (EDD)?

Accepted Answer

5%

Answer

15%

Answer

20%

Answer

10%

Question 2

What is the timing for the highest risk of Pelvic Inflammatory Disease (PID) after the insertion of an Intrauterine Device (IUD)?

Accepted Answer

Within 3 weeks

Answer

Within 5 weeks

Answer

Within 7 weeks

Answer

Within 14 weeks

Question 3

What is the purpose of the Prague maneuver in obstetrics?

Accepted Answer

To deliver the head in breech presentation when the fetal back is posterior

Answer

To assess the fetal position in deep transverse arrest

Answer

To extract extended arms during delivery

Answer

To turn a fetus from breech to head-down position before labor

Question 4

In which obstetric condition is assisted head delivery typically performed?

Accepted Answer

Breech presentation

Answer

Shoulder dystocia

Answer

Transverse lie

Answer

Normal delivery

Question 5

What is Hegar's sign in obstetrics?

Accepted Answer

Softening of the uterine isthmus

Answer

Uterine contractions

Answer

Fetal movement

Answer

Cyanosis of the vagina

Question 6

Bishop scoring is done for ?

Accepted Answer

Induction of labor assessment

Answer

Exchange transfusion in newborns

Answer

Newborn ventilation assessment

Answer

Newborn gestation assessment

Question 7

Which of the following is the most common genital infection in pregnancy?

Accepted Answer

Vaginal candidiasis

Answer

Gonorrhea

Answer

Chlamydia

Answer

Bacterial vaginosis

Question 8

A patient presents with bilateral ovarian carcinoma, capsule involvement, ascites, and paraaortic lymphadenopathy. What is the appropriate stage of the disease?

Accepted Answer

Stage 3C

Answer

Stage 1C

Answer

Stage 2C

Answer

Stage 4C

Question 9

Commonest variety of compound presentation is?

Accepted Answer

Head with hand

Answer

Head with both feet

Answer

Head, hand & feet

Answer

Head with feet

Question 10

Which of the following statements about radical hysterectomy in stage Ib cervical cancer compared to radiotherapy is false?

Accepted Answer

It is less complicated than radiotherapy.

Answer

Chance of recurrence is lower with radical hysterectomy.

Answer

Ovarian function can be preserved.

Answer

Chance of survival is higher with radical hysterectomy.

NEET-PG 2013 — Obstetrics and Gynecology