NEET-PG 2020 - Obstetrics and Gynecology Practice Questions

Q: Which of the following is not used for postcoital contraception?

Danazol. ***Danazol*** - **Danazol** is an androgen derivative primarily used to treat conditions like **endometriosis** and **fibrocystic breast disease** due to its ability to suppress gonadotropin secretion. - It is **not effective** as a postcoital contraceptive as it does not reliably prevent ovulation, fertilization, or implantation when taken after unprotected intercourse. *CuT* - The **copper-T intrauterine device (CuT IUD)** can be inserted within **5 days** of unprotected intercourse as an effective form of emergency contraception. - Its mechanism involves releasing **copper ions** that are toxic to sperm and eggs, inhibiting fertilization and implantation. *Ru 486* - **Mifepristone (RU 486)** is an **anti-progestin** that can be used for emergency contraception (often referred to as the morning-after pill). - It works by delaying or inhibiting ovulation and preventing implantation by altering the **endometrium**. *High dose estrogen* - High doses of **estrogen**, often in combination with progestin (**Yuzpe regimen**), can be used as emergency contraception. - This method primarily works by **disrupting ovulation** and altering the endometrium to prevent implantation.

Q: A 7 weeks pregnant lady has 1 accidental exposure to x-ray. Which of the following should be done?

Continue the pregnancy with monitoring. ***Continue the pregnancy with monitoring*** - The risk of **fetal malformation** and **intellectual disability** from a single diagnostic X-ray exposure is generally considered very low, often below the threshold for clinical concern. - Current guidelines typically recommend continuing pregnancy with routine monitoring unless the estimated fetal dose exceeds a certain threshold (e.g., 50-100 mGy), which is unlikely with a single accidental exposure. *Perform chromosome analysis if needed* - **Chromosome analysis** is generally reserved for cases with suspected genetic anomalies or significant fetal exposure to radiation at doses known to induce chromosomal damage. - A single, accidental X-ray exposure is unlikely to cause clinically significant chromosomal aberrations requiring such invasive testing. *Conduct pre-invasive diagnostic testing if indicated* - **Pre-invasive diagnostic testing**, such as nuchal translucency scans or maternal serum screening, assesses risks for common aneuploidies and neural tube defects, not typically direct radiation effects. - While these tests are part of routine prenatal care, a single X-ray exposure does not, by itself, create a specific indication for additional pre-invasive testing beyond standard recommendations. *Consider termination of pregnancy* - **Termination of pregnancy** is usually considered only in cases of significant, confirmed fetal harm or very high radiation doses that unequivocally increase the risk of severe birth defects or intellectual disability. - A single accidental X-ray exposure almost certainly does not meet this threshold, as the associated risks to the fetus are minimal.

Q: What is the best treatment option for a septate uterus?

Transcervical hysteroscopic resection of the septum. ***Transcervical hysteroscopic resection of the septum*** - This procedure involves using a **hysteroscope** to visualize and resect the **fibrous or muscular septum** that divides the uterine cavity, restoring a normal uterine shape. - It is considered the gold standard due to its **minimally invasive nature**, effectiveness in improving reproductive outcomes, and lower risk of complications compared to abdominal approaches. *Tompkins Metroplasty* - This is an **abdominal surgical procedure** primarily used for the repair of a **bicornuate uterus**, not typically for a septate uterus. - It involves resecting the uterine fundus to create a single uterine cavity, which is more invasive than hysteroscopic septum resection. *Jones metroplasty* - This procedure is also an **abdominal approach** used for the surgical correction of a **bicornuate uterus**, not a septate uterus. - It involves excising the septal portion and approximating the uterine walls. *Strassmann metroplasty* - This is another **abdominal surgical technique** that is primarily indicated for the repair of a **bicornuate or didelphys uterus**, where a large defect needs to be corrected. - It involves reconstructing the uterus through a fundal incision, which is significantly more invasive than hysteroscopic septal resection for a septate uterus.

Q: A mother brought her 16-year-old daughter to Gynaecology OPD with a complaint of not attaining menarche. She gives a history of cyclic abdominal pain. On further examination, a midline abdominal swelling is seen. Per rectal examination reveals a bulging mass in the vagina. Which of the following conditions is most likely responsible for these findings?

Imperforate hymen. ***Imperforate hymen*** - An **imperforate hymen** obstructs the outflow of menstrual blood, leading to its accumulation in the vagina (**hematocolpos**) and uterus (**hematometra**), causing **cyclic abdominal pain** and a bulging mass (due to accumulated blood) in the vagina. - The patient presents with **primary amenorrhea** (not having attained menarche) and cyclical abdominal pain caused by the inability of menstrual blood to exit the body. *Transverse vaginal septum* - A **transverse vaginal septum** can also cause primary amenorrhea and cyclic abdominal pain due to obstruction of menstrual flow. However, it is a less common cause than an imperforate hymen. - While it can lead to hematocolpos, the characteristic bulging mass on per rectal examination is more strongly associated with an imperforate hymen presenting at the vaginal introitus. *Vaginal agenesis* - **Vaginal agenesis** (complete absence of the vagina) would present with primary amenorrhea, but there would be no cyclic abdominal pain if the uterus is also absent or rudimentary. If a uterus is present, there would be no accumulation of blood in the vagina or a bulging mass per rectum as there is no vaginal canal. - This condition is typically associated with a rudimentary or absent uterus, leading to an inability to menstruate rather than obstructed flow. *Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome* - **MRKH syndrome** is characterized by congenital aplasia of the uterus and the upper two-thirds of the vagina, with normal ovaries and external genitalia. - Patients present with **primary amenorrhea** but typically do not experience **cyclic abdominal pain** or a bulging vaginal mass because there is no functional uterus to produce menstrual blood or a vaginal canal for blood accumulation.

Q: Which of the following is not considered an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?

Uterine malformation. ***Uterine malformation*** - While a uterine malformation can make IUD insertion more difficult or reduce its effectiveness, it is often considered a **relative contraindication**, depending on the specific anomaly and the patient's desire for contraception. - In certain cases, an IUD might still be a viable option, but it requires careful consideration and specialized insertion techniques. *Pregnancy* - The presence of an existing pregnancy is an **absolute contraindication** for IUD insertion, as it can lead to complications such as miscarriage or ectopic pregnancy. - An IUD is a contraceptive device, and inserting it when a woman is already pregnant directly contradicts its purpose and poses significant risks. *Undiagnosed vaginal bleeding* - This is an **absolute contraindication** because it could be a symptom of a serious underlying condition, such as cervical cancer, endometrial cancer, or ectopic pregnancy. - Inserting an IUD before diagnosing the cause of the bleeding could delay treatment of a potentially life-threatening condition and exacerbate the bleeding. *Pelvic inflammatory disease* - Current or recent (within the last 3 months) **pelvic inflammatory disease (PID)** is an **absolute contraindication** due to the increased risk of worsening infection. - IUD insertion can introduce bacteria from the vagina into the uterus, potentially exacerbating an existing infection or causing a new one.

Q: A 24-year-old woman who had a home delivery 2 weeks ago now presents with a complete perineal tear. What is the next line of management?

Repair after 3 months. ***Repair after 3 months*** - Delayed repair, typically after **3 to 6 months**, allows for resolution of **inflammation**, re-epithelialization of the wound edges, and softening of the scar tissue. - This timing optimizes conditions for successful surgical reconstruction by minimizing the risk of **infection** and promoting better tissue healing. *Repair after 3 weeks* - Repairing a complete perineal tear at this stage is too early as the tissue is still highly **inflamed** and prone to **infection** and **dehiscence**. - The wound bed would not have sufficiently healed or softened, making surgical repair more challenging and increasing the likelihood of poor outcomes. *Repair after 6 months* - Waiting for 6 months to repair a complete perineal tear is generally considered too long, as the tissues may become excessively **fibrotic** and less amenable to successful reconstruction. - While sometimes necessary in complex cases, waiting this long can lead to prolonged discomfort and functional issues for the patient. *Repair immediately* - Immediate repair of a complete perineal tear that was missed or inadequately repaired at the time of delivery is typically not recommended several weeks postpartum due to significant **edema**, **inflammation**, and potential for **infection**. - Immediate repair is usually performed **at the time of delivery** if the tear is recognized, not two weeks later.

Q: A woman with 18 weeks gestation presented to the OPD. On abdominal examination, the uterine size was 16 weeks. On USG, oligohydramnios was found, which of the following is suspected?

Renal agenesis. ***Renal agenesis*** - **Oligohydramnios** (low amniotic fluid) and a **smaller-than-expected uterine size** at 18 weeks gestation are strong indicators of fetal renal agenesis. - Fetal kidneys are crucial for producing amniotic fluid through urine excretion, so their absence or severe malfunction leads to insufficient fluid. *Jaundice* - Not directly associated with **oligohydramnios** or a smaller uterine size. - While it can occur in utero, it doesn't cause a reduction in amniotic fluid volume. *Fetal anemia* - Often associated with **hydrops fetalis** and **polyhydramnios** (excess amniotic fluid), due to increased cardiac output and fluid retention, rather than oligohydramnios. - Doesn't typically present with a uterus smaller than expected for gestational age. *Anencephaly* - A neural tube defect characterized by the absence of a major portion of the brain and skull. - It is usually associated with **polyhydramnios** (excess amniotic fluid) due to impaired fetal swallowing, making it inconsistent with the given findings.

Q: 35 yr old primigravida conceived after IVF cycle attends obstetrics clinic with 38 weeks gestation. Her obstetric details reveal DiCho-DiAmn twins with 1st twin as breech. Her BP was 140/90 mmHg on 2 occasions with proteinuria +1. How will you manage this case?

Plan a cesarean for termination. ***Plan a cesarean for termination*** - This patient presents with **preeclampsia** (BP 140/90 mmHg on two occasions with proteinuria +1) at **38 weeks gestation**, making delivery appropriate. - The presence of **DiCho-DiAmn twins** with the **first twin in breech presentation** is a strong indication for **cesarean section** to ensure safe delivery and reduce complications. *Induction of labour* - While induction might be considered for preeclampsia, the **breech presentation of the first twin** in a twin pregnancy significantly increases the risks associated with vaginal delivery, making it less safe than a cesarean. - Given the combined risk factors, **cesarean delivery** is the more appropriate choice for optimizing maternal and fetal outcomes. *Watch for BP and induce for normal delivery on Expected Date of delivery* - Preeclampsia necessitates **delivery when the mother reaches 37 weeks or beyond**, not necessarily waiting until the Expected Date of Delivery, especially with other complicating factors. - Furthermore, attempting a **normal vaginal delivery** with a **breech presenting twin 1** carries high risks for both twins and is generally contraindicated. *Watch for BP and terminate (vaginal/ Cesarean) only when BP is normal.* - Delaying termination until blood pressure normalizes is not appropriate management for **preeclampsia** at term; delivery is the definitive treatment. - A persistent **breech presentation of twin 1** also makes vaginal delivery problematic, regardless of blood pressure status.

Q: 35 yr old lady attends gynaec OPD with excessive bleeding since 6 months, not controlled with non hormonal drugs. USG and clinical examination reveals no abnormality. Next step is?

Endometrial sampling. ***Endometrial sampling*** - In a 35-year-old with **excessive uterine bleeding** not controlled by non-hormonal drugs and with normal imaging/clinical exam, endometrial sampling is crucial to **rule out endometrial hyperplasia or malignancy**. - This diagnostic step is essential before considering definitive treatments, as it provides a **histological diagnosis** of the endometrial lining. *Hysterectomy* - Hysterectomy is a **definitive surgical treatment** for excessive bleeding, but it is typically reserved for cases where conservative or less invasive treatments have failed, or if there's a serious underlying pathology like malignancy. - It involves removing the uterus and is a **major surgery** with potential complications, thus not usually the first step given an otherwise normal examination and imaging. *Endometrial ablation* - Endometrial ablation is a procedure to destroy the lining of the uterus, aiming to **reduce or stop menstrual bleeding**. - It is a treatment option for **abnormal uterine bleeding (AUB)**, but it's typically performed after other diagnostic steps (like endometrial sampling) have ruled out malignancy or high-risk hyperplasia, and when conservative medical management has failed. *Hormonal therapy* - Hormonal therapy (e.g., combined oral contraceptives, progestin-only pills, levonorgestrel-releasing intrauterine device) is often a **first-line medical treatment** for excessive uterine bleeding. - However, the question states that non-hormonal drugs have already failed, and without a clear diagnosis, initiating new hormonal therapy without **evaluating the endometrium** is not the next best step for persistent bleeding.

Q: A 60 years old Female with intermittent bleeding per vagina, endometrial collection, and thickening with anterior bulging of the fundal area on ultrasound. What is the most probable diagnosis?

Endometrial Polyp. ***Endometrial Polyp*** - Intermittent bleeding and an **endometrial collection** with **thickening** are classic signs of an endometrial polyp. - The **anterior bulging of the fundal area** on ultrasound is characteristic of a **localized, sessile polyp** protruding into the endometrial cavity. - Polyps are benign overgrowths of endometrial tissue that commonly present with postmenopausal bleeding. *Submucous Fibroid* - While submucous fibroids can cause intermittent bleeding and fundal bulging, they typically appear as a distinct **hypoechoic mass arising from the myometrium** with a whorled pattern. - Fibroids are solid lesions, whereas the description of "endometrial collection" suggests a more cystic or polypoid nature. *Adenomyosis* - Adenomyosis involves **endometrial tissue within the myometrium**, typically causing diffuse uterine enlargement with a heterogeneous myometrial echotexture. - It usually presents with **dysmenorrhea and menorrhagia** rather than intermittent bleeding with focal fundal bulging. - The ultrasound findings described are more consistent with an **intracavitary lesion** rather than myometrial pathology. *Endometrial Cancer* - Endometrial cancer is an important consideration in postmenopausal bleeding with endometrial thickening. - However, malignancy typically presents with a **heterogeneous, irregular endometrial pattern** with increased vascularity on Doppler. - The description of a **discrete collection with focal bulging** points more toward a **benign, localized lesion** like a polyp rather than diffuse malignancy.

Question 1

Which of the following is not used for postcoital contraception?

Accepted Answer

Danazol

Answer

CuT

Answer

Ru 486

Answer

High dose estrogen

Question 2

A 7 weeks pregnant lady has 1 accidental exposure to x-ray. Which of the following should be done?

Accepted Answer

Continue the pregnancy with monitoring

Answer

Perform chromosome analysis if needed

Answer

Conduct pre-invasive diagnostic testing if indicated

Answer

Consider termination of pregnancy

Question 3

What is the best treatment option for a septate uterus?

Accepted Answer

Transcervical hysteroscopic resection of the septum

Answer

Tompkins Metroplasty

Answer

Jones metroplasty

Answer

Strassmann metroplasty

Question 4

A mother brought her 16-year-old daughter to Gynaecology OPD with a complaint of not attaining menarche. She gives a history of cyclic abdominal pain. On further examination, a midline abdominal swelling is seen. Per rectal examination reveals a bulging mass in the vagina. Which of the following conditions is most likely responsible for these findings?

Accepted Answer

Imperforate hymen

Answer

Vaginal agenesis

Answer

Transverse vaginal septum

Answer

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome

Question 5

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

Accepted Answer

Uterine malformation

Answer

Undiagnosed vaginal bleeding

Answer

Pregnancy

Answer

Pelvic inflammatory disease

Question 6

A 24-year-old woman who had a home delivery 2 weeks ago now presents with a complete perineal tear. What is the next line of management?

Accepted Answer

Repair after 3 months

Answer

Repair after 3 weeks

Answer

Repair after 6 months

Answer

Repair immediately

Question 7

A woman with 18 weeks gestation presented to the OPD. On abdominal examination, the uterine size was 16 weeks. On USG, oligohydramnios was found, which of the following is suspected?

Accepted Answer

Renal agenesis

Answer

Jaundice

Answer

Fetal anemia

Answer

Anencephaly

Question 8

35 yr old primigravida conceived after IVF cycle attends obstetrics clinic with 38 weeks gestation. Her obstetric details reveal DiCho-DiAmn twins with 1st twin as breech. Her BP was 140/90 mmHg on 2 occasions with proteinuria +1. How will you manage this case?

Accepted Answer

Plan a cesarean for termination

Answer

Induction of labour

Answer

Watch for BP and induce for normal delivery on Expected Date of delivery

Answer

Watch for BP and terminate (vaginal/ Cesarean) only when BP is normal.

Question 9

35 yr old lady attends gynaec OPD with excessive bleeding since 6 months, not controlled with non hormonal drugs. USG and clinical examination reveals no abnormality. Next step is?

Accepted Answer

Endometrial sampling

Answer

Hysterectomy

Answer

Endometrial ablation

Answer

Hormonal therapy

Question 10

A 60 years old Female with intermittent bleeding per vagina, endometrial collection, and thickening with anterior bulging of the fundal area on ultrasound. What is the most probable diagnosis?

Accepted Answer

Endometrial Polyp

Answer

Submucous Fibroid

Answer

Adenomyosis

Answer

Endometrial Cancer

NEET-PG 2020 — Obstetrics and Gynecology