INI-CET 2024 - Obstetrics and Gynecology PYQs Practice Questions

Q: What is the correct dosing regimen of Dexamethasone for promoting fetal lung maturity in preterm infants?

Dexamethasone 6 mg - 4 doses every 12 hrly. **Dexamethasone 6 mg - 4 doses every 12 hrly** - The standard recommended dosing for **Dexamethasone** to promote fetal lung maturity is **6 mg intramuscularly every 12 hours for a total of four doses.** - This regimen ensures adequate **antenatal corticosteroid** exposure to enhance surfactant production and reduce the incidence and severity of **respiratory distress syndrome** in preterm infants. *Dexamethasone 6 mg - 2 doses every 12 hrly* - This regimen administers only **half the recommended total dose** of Dexamethasone. - It is **insufficient** to achieve the full benefits of antenatal corticosteroids for fetal lung maturity. *Betamethasone 12 mg - 2 doses every 24 hrly* - This is the correct dosing regimen for **Betamethasone**, not Dexamethasone. - While both are antenatal corticosteroids, their dosages and administration schedules differ. *Betamethasone 6 mg - 4 doses every 12 hrly* - This option uses an **incorrect total dose and frequency** for **Betamethasone**. - The standard Betamethasone regimen is 12 mg every 24 hours for two doses. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: 18 weeks pregnant female presents with no high risk of NTD and low risk of trisomy 21 on quad test. What is the most appropriate next step in management?

Perform a detailed fetal ultrasound.. ***Perform a detailed fetal ultrasound.*** - A **detailed fetal ultrasound** (often referred to as an **anatomy scan**) at around 18-22 weeks is a standard component of prenatal care for all pregnant women, regardless of screening test results. - This ultrasound evaluates fetal anatomy for structural anomalies, assesses fetal growth, and confirms gestational age, providing crucial information even with low-risk screening. *Repeat non-invasive screening test.* - Repeating a non-invasive screening test (like another quad screen or NIPT) is generally **not indicated** when initial results show a low risk and there are no other clinical concerns. - Such tests are primarily for screening purposes, and a second low-risk result would offer little additional actionable information, as their positive predictive value is low. *Perform invasive diagnostic testing.* - **Invasive diagnostic testing**, such as **amniocentesis** or **chorionic villus sampling (CVS)**, carries a risk of miscarriage and is reserved for situations with a high risk of chromosomal abnormalities or genetic conditions. - Given the low-risk quad screen results for trisomy 21 and no high risk for NTDs, invasive testing is **not warranted** at this stage. *Perform amniotic fluid analysis.* - **Amniotic fluid analysis** is part of an amniocentesis, an **invasive diagnostic procedure** designed to detect chromosomal abnormalities or genetic disorders. - This procedure is typically reserved for cases where screening tests indicate a high risk or there is a clinical suspicion of a genetic condition; it's **not a routine step** after a low-risk quad screen. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What are the criteria for administering Anti-D immunoglobulin postpartum in an Rh-negative female?

DCT negative, Baby Rh +ve. ***DCT negative, Baby Rh +ve*** * The mother is **Rh-negative** and needs Anti-D immunoglobulin if her baby is **Rh-positive** to prevent sensitization. * A **negative Direct Coombs Test (DCT)** indicates that the mother has not yet developed antibodies against the baby's Rh-positive red blood cells, making Anti-D administration effective for prevention. * *DCT positive, Baby Rh +ve* * If the **DCT is positive**, it means the mother has already formed **antibodies** against the baby's Rh-positive red blood cells (sensitization has occurred). * In this scenario, administering Anti-D immunoglobulin would be **ineffective** as the immune response has already begun. * *DCT negative, Baby Rh -ve* * If the baby is **Rh-negative**, there is no risk of Rh sensitization for an Rh-negative mother. * Therefore, **Anti-D immunoglobulin is not necessary** in this situation. * *DCT positive, Baby Rh -ve* * A **positive DCT** in an Rh-negative mother implies sensitization has occurred, but it would not be due to an Rh-negative baby. * Administering Anti-D immunoglobulin would be **ineffective** and unnecessary if the baby is Rh-negative. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A G2 P1 female with 6 weeks amenorrhea presents with bleeding PV, hypotension, and altered sensorium. She has pain in the abdomen and on per vaginal examination cervical movement tenderness is present. On USG, there is free fluid present in the right paracolic gutter. What is the most probable diagnosis?

Ruptured ectopic. ***Ruptured ectopic*** - The combination of **amenorrhea**, **vaginal bleeding**, **abdominal pain**, and signs of **hypovolemic shock** (hypotension, altered sensorium) is highly suggestive of a ruptured ectopic pregnancy. - The presence of **cervical motion tenderness** and **free fluid in the paracolic gutter** on ultrasound strongly indicates intra-abdominal hemorrhage. *Abruptio placenta* - This condition typically occurs in the **second or third trimester** of pregnancy, not at 6 weeks gestation. - While it causes vaginal bleeding and abdominal pain, the presentation of **profound shock** in early pregnancy with free fluid suggests an ectopic rupture rather than placental abruption. *Placenta previa* - **Painless vaginal bleeding** in the second or third trimester is characteristic of placenta previa. - It would not explain the severe abdominal pain, cervical motion tenderness, or signs of hypovolemic shock in a 6-week pregnancy. *Missed abortion* - A missed abortion involves the **death of the embryo/fetus** with retention of products of conception, often with minimal or no symptoms. - It would not typically present with **hypotension**, **altered sensorium**, **severe abdominal pain**, or **free fluid in the abdomen**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 32-year-old female at 36 weeks of pregnancy presents with BP 170/100 mmHg, visual disturbances, headache, urine protein 3+. What will be the next step?

IV labetalol, magnesium sulfate (MgSO4), expedite delivery. ***IV labetalol, magnesium sulfate (MgSO4), expedite delivery*** - The patient presents with **severe preeclampsia** (BP > 160/110 mmHg, visual disturbances, headache, proteinuria) at 36 weeks, requiring **antihypertensive therapy** (labetalol) and seizure prophylaxis (**magnesium sulfate**). - Given the severe features and gestational age, **expedited delivery** is indicated to prevent maternal and fetal complications, as expectant management beyond severe preeclampsia at this stage offers minimal benefit and increased risk. *IV labetalol and delivery at 37 weeks* - While IV labetalol is appropriate for **blood pressure control**, delaying delivery to 37 weeks might not be optimal given the **severe features of preeclampsia** at 36 weeks, increasing risks for both mother and fetus. - The plan is incomplete without mentioning **seizure prophylaxis** with magnesium sulfate, which is crucial for severe preeclampsia. *IV labetalol, dexamethasone, and immediate termination of pregnancy* - **Dexamethasone** is used for **fetal lung maturity** in preterm deliveries and is not indicated for immediate termination unless the fetus is preterm and lung maturity is a concern. At 36 weeks, lung maturity is usually established. - While immediate termination might be considered, the phrase "immediate termination" implies C-section without considering vaginal delivery and overlooks the need for **seizure prophylaxis**. *IV labetalol, dexamethasone, and conservative management* - **Dexamethasone** is not a primary treatment for severe preeclampsia itself but rather for **fetal lung maturation** in preterm deliveries, which is less critical at 36 weeks. - **Conservative management** is generally inappropriate for **severe preeclampsia** at 36 weeks, as it increases maternal and fetal risk; delivery is the definitive treatment. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

What is the correct dosing regimen of Dexamethasone for promoting fetal lung maturity in preterm infants?

Accepted Answer

Dexamethasone 6 mg - 4 doses every 12 hrly

Answer

Dexamethasone 6 mg - 2 doses every 12 hrly

Answer

Betamethasone 12 mg - 2 doses every 24 hrly

Answer

Betamethasone 6 mg - 4 doses every 12 hrly

Question 2

18 weeks pregnant female presents with no high risk of NTD and low risk of trisomy 21 on quad test. What is the most appropriate next step in management?

Accepted Answer

Perform a detailed fetal ultrasound.

Answer

Repeat non-invasive screening test.

Answer

Perform invasive diagnostic testing.

Answer

Perform amniotic fluid analysis.

Question 3

What are the criteria for administering Anti-D immunoglobulin postpartum in an Rh-negative female?

Accepted Answer

DCT negative, Baby Rh +ve

Answer

DCT positive, Baby Rh +ve

Answer

DCT negative, Baby Rh -ve

Answer

DCT positive, Baby Rh -ve

Question 4

A G2 P1 female with 6 weeks amenorrhea presents with bleeding PV, hypotension, and altered sensorium. She has pain in the abdomen and on per vaginal examination cervical movement tenderness is present. On USG, there is free fluid present in the right paracolic gutter. What is the most probable diagnosis?

Accepted Answer

Ruptured ectopic

Answer

Abruptio placenta

Answer

Placenta previa

Answer

Missed abortion

Question 5

A 32-year-old female at 36 weeks of pregnancy presents with BP 170/100 mmHg, visual disturbances, headache, urine protein 3+. What will be the next step?

Accepted Answer

IV labetalol, magnesium sulfate (MgSO4), expedite delivery

Answer

IV labetalol and delivery at 37 weeks

Answer

IV labetalol, dexamethasone, and immediate termination of pregnancy

Answer

IV labetalol, dexamethasone, and conservative management

INI-CET 2024 — Obstetrics and Gynecology