Which of the following cannot be used as Post-coital contraceptive?
A 7-week pregnant lady underwent a chest X-ray by mistake. What is to be done?
A 24-year-old woman with a married life of 4 years visits an infertility clinic with a history of recurrent abortion. On further workup, she is found to have a septate uterus. Which surgery has the best reproductive outcome?
In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?
Which of the following is NOT used as an emergency contraceptive?
Episotomy extended posteriorly beyond perineal body injuring structure posterior to it, which structure is injured?
26 yr lady with delayed cycles presents to the infertility clinic. After diagnosing her to be a case anovulation of 'Normogonadotropic Hypogonadism' type she was put on human menopausal gonadotropin (HMG) for ovulation induction from the second day of her menstrual period. She was 'Triggered' for follicular rupture with Human chorionic gonadotropin (hCG) and on the 19th day of this cycle she developed dyspnoea, reduced urine output, abdominal bloating and pain. What condition is this patient likely suffering from?
A female patient presents with multiple sessile lesions on the vulva that do not bleed on touch. What is the most likely diagnosis?
24 yr old mother with 7 week POG presents to ANC OPD with accidental low-dose radiation exposure. What is the most appropriate immediate management?
NEET-PG 2020 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 21: Which of the following cannot be used as Post-coital contraceptive?
- A. A device that prevents fertilization and implantation (e.g., CuT 200)
- B. A hormonal method that disrupts ovulation (e.g., high-dose estrogens)
- C. A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol) (Correct Answer)
- D. A progesterone receptor blocker used within 72 hours (e.g., RU 486)
Explanation: ***A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol)*** - **Danazol** is an **androgen derivative** primarily used to treat endometriosis and fibrocystic breast disease due to its *anti-estrogenic* and *anti-progestational* effects. - It does not have a primary role as a **post-coital contraceptive** and is not approved for this indication. *A device that prevents fertilization and implantation (e.g., CuT 200)* - The **CuT 200 (copper T intrauterine device)** can be inserted as an **emergency contraceptive** within five days of unprotected intercourse. - It works by causing a **spermicidal effect** within the uterus and preventing implantation if fertilization occurs. *A hormonal method that disrupts ovulation (e.g., high-dose estrogens)* - High-dose **estrogens alone** or in combination with progesterone can be used as **emergency contraception** (e.g., the Yuzpe method). - These hormones disrupt the hormonal cascade necessary for **ovulation** or alter the endometrial lining to prevent implantation. *A progesterone receptor blocker used within 72 hours (e.g., RU 486)* - **RU 486 (Mifepristone)** is a **progesterone receptor blocker** that can be used as an emergency contraceptive within 72 (or sometimes up to 120) hours of unprotected intercourse. - It works by **delaying or inhibiting ovulation** and by altering the endometrium, making it unsuitable for implantation.
Question 22: A 7-week pregnant lady underwent a chest X-ray by mistake. What is to be done?
- A. Terminate the pregnancy immediately due to radiation exposure.
- B. Perform chromosomal testing to assess fetal damage.
- C. Reassure the patient and continue the pregnancy. (Correct Answer)
- D. Conduct prenatal invasive diagnostic tests to evaluate fetal health.
Explanation: **Reassure the patient and continue the pregnancy.** - A single chest X-ray delivers a **negligible dose of radiation (around 0.01 mGy)** to the embryo/fetus, which is significantly below the threshold for causing congenital abnormalities or pregnancy loss. - The **teratogenic threshold** for radiation exposure is generally considered to be around **50-100 mGy**, making a single chest X-ray exposure well within safe limits. *Terminate the pregnancy immediately due to radiation exposure.* - There is **no clinical justification** for pregnancy termination based on a single chest X-ray, as the radiation dose is far too low to cause significant harm. - Such an intervention would be based on **misinformation** and could lead to unnecessary emotional distress and ethical concerns. *Perform chromosomal testing to assess fetal damage.* - Chromosomal testing is **not indicated** for low-dose radiation exposure from a single chest X-ray, as this type of exposure is unlikely to cause chromosomal abnormalities. - The radiation dose is simply too low to inflict the kind of damage that would necessitate such invasive and often risky procedures. *Conduct prenatal invasive diagnostic tests to evaluate fetal health.* - Invasive prenatal diagnostic tests, such as **amniocentesis or chorionic villus sampling**, carry their own risks and are not warranted for a benign exposure like a chest X-ray. - These tests are typically reserved for situations with a much higher established risk of fetal anomalies.
Question 23: A 24-year-old woman with a married life of 4 years visits an infertility clinic with a history of recurrent abortion. On further workup, she is found to have a septate uterus. Which surgery has the best reproductive outcome?
- A. Tompkins procedure
- B. Hysteroscopic surgery (Correct Answer)
- C. Jones procedure
- D. Strassman procedure
Explanation: ***Hysteroscopic surgery*** - This minimally invasive procedure involves resecting the **septum** using a hysteroscope, which is associated with excellent reproductive outcomes, often achieving **term pregnancy rates of 70-80%**. - It is preferred because it avoids hysterotomy (incision into the uterus), preserving uterine integrity and reducing the risk of future complications during pregnancy and delivery. *Tompkins procedure* - This procedure involves a **laparotomy and longitudinal incision** into the uterus to excise the septum, followed by closure. - While effective, it is a more invasive open surgical approach, leading to a **longer recovery time** and potentially compromising uterine integrity, increasing the risk of future uterine rupture. *Jones procedure* - The Jones procedure is also an **abdominal metroplasty** that involves excising a wedge of tissue from the fundus of the uterus, typically used for **bicornuate uteri**. - It is **highly invasive** and not the preferred method for a septate uterus due to its extensive nature and associated risks. *Strassman procedure* - The Strassman procedure is primarily used for the surgical correction of a **bicornuate uterus** or **uterus didelphys**, involving unification of the two uterine horns. - This procedure is also an **open abdominal surgery** with significant recovery time and risks, and is not applicable for a septate uterus, where the issue is a fibrous or muscular wall within a single uterine cavity.
Question 24: In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?
- A. Biophysical profile
- B. Amniotic fluid spectrophotometry
- C. Middle cerebral artery Doppler wave forms (Correct Answer)
- D. Fetal blood sampling
Explanation: ***Middle cerebral artery Doppler wave forms*** - This is currently the most widely accepted and **non-invasive** method for monitoring **fetal anemia** in Rh-sensitized pregnancies. - An increase in the **peak systolic velocity (PSV)** in the middle cerebral artery indicates that the fetus is increasing cardiac output to compensate for a reduced oxygen-carrying capacity due to anemia. *Biophysical profile* - The biophysical profile assesses various fetal parameters like **movement**, **tone**, **breathing**, and **amniotic fluid volume**, which are often altered late in the course of severe fetal anemia. - It is a **less sensitive** indicator of early or moderate fetal anemia compared to MCA Doppler. *Amniotic fluid spectrophotometry* - This method measures the **bilirubin levels** in amniotic fluid, which correlates with the severity of hemolysis. - It is an **invasive procedure** (amniocentesis) and has largely been replaced by non-invasive MCA Doppler due to associated risks and better predictive value of Doppler. *Fetal blood sampling* - Fetal blood sampling (cordocentesis) provides a direct measurement of **fetal hemoglobin** and other blood parameters. - While definitive, it is a **highly invasive procedure** with significant risks, reserved primarily for confirmation of severe anemia or for direct transfusion, not for routine monitoring.
Question 25: Which of the following is NOT used as an emergency contraceptive?
- A. RU 486
- B. Danazol (Correct Answer)
- C. Copper T
- D. OCpill
Explanation: ***Danazol*** - **Danazol** is an **androgen derivative** primarily used to treat **endometriosis** and **fibrocystic breast disease**, not for emergency contraception. - Its mechanism involves suppressing **ovarian function** and creating an anovulatory state, which is not suitable for immediate post-coital intervention. *RU 486* - **RU 486 (Mifepristone)** is a **progesterone receptor modulator** that can be used as an emergency contraceptive, especially at higher doses. - It acts by **blocking progesterone receptors**, preventing implantation or inducing abortion if pregnancy has already occurred. *Copper T* - The **Copper T (intrauterine device - IUD)** is a highly effective method of emergency contraception if inserted within 5 days of unprotected intercourse. - It works by causing a **spermicidal effect** and preventing fertilization or implantation by inducing an inflammatory reaction in the uterus. *OCpill* - **OCPills (oral contraceptive pills)**, usually a combination of estrogen and progestin, can be used as emergency contraception when taken in higher doses. - This method, known as the **Yuzpe regimen**, involves taking two doses of combined oral contraceptives within 72 hours of unprotected intercourse to inhibit ovulation or fertilization.
Question 26: Episotomy extended posteriorly beyond perineal body injuring structure posterior to it, which structure is injured?
- A. Urethral sphincter
- B. Ischiocavernosus
- C. External anal sphincter (Correct Answer)
- D. Bulbospongiosus
Explanation: ***External anal sphincter*** - An episiotomy extending posteriorly beyond the **perineal body** (the central tendon of the perineum) is likely to involve the **external anal sphincter (EAS)**, which lies immediately posterior to the perineal body. - Injury to the EAS can lead to **fecal incontinence** due to its role in voluntary control of defecation. *Urethral sphincter* - The **urethral sphincter** is located anterior to the vaginal introitus and is not typically affected by a posterior extension of an episiotomy. - Damage to the urethral sphincter would lead to **urinary incontinence**, not directly related to posterior perineal injury. *Ischiocavernosus* - The **ischiocavernosus muscle** covers the crus of the clitoris (or penis in males) and is located more laterally and anteriorly in the perineum. - Its primary role is in **clitoral (or penile) erection**, and it is generally not injured by an episiotomy, especially one extending posteriorly. *Bulbospongiosus* - The **bulbospongiosus muscle** surrounds the vaginal opening and bulb of the vestibule, lying superficial to the perineal membrane. - While an episiotomy cuts through this muscle, a posterior extension *beyond* the perineal body would primarily involve structures further back, such as the **external anal sphincter**, not just the bulbospongiosus.
Question 27: 26 yr lady with delayed cycles presents to the infertility clinic. After diagnosing her to be a case anovulation of 'Normogonadotropic Hypogonadism' type she was put on human menopausal gonadotropin (HMG) for ovulation induction from the second day of her menstrual period. She was 'Triggered' for follicular rupture with Human chorionic gonadotropin (hCG) and on the 19th day of this cycle she developed dyspnoea, reduced urine output, abdominal bloating and pain. What condition is this patient likely suffering from?
- A. Ruptured ectopic pregnancy
- B. Ruptured corpus luteum cyst
- C. Ovarian hyperstimulation syndrome (Correct Answer)
- D. Theca lutein cysts
Explanation: ***Ovarian hyperstimulation syndrome*** - The patient's history of **ovulation induction** using **HMG** followed by an **hCG trigger** and subsequent symptoms of **dyspnea**, **reduced urine output**, **abdominal bloating**, and pain strongly indicate **ovarian hyperstimulation syndrome (OHSS)**. - **hCG** exacerbates OHSS by increasing vascular permeability, leading to fluid shifts into the third space and resulting in effusions (e.g., ascites, pleural effusion) and hemoconcentration. *Ruptured ectopic pregnancy* - While an **ectopic pregnancy** can cause abdominal pain, it typically presents with a **positive pregnancy test** and **vaginal bleeding**, which are not mentioned. - Dyspnea and reduced urine output are not typical initial symptoms of ruptured ectopic pregnancy; rather, **hypovolemic shock** would be expected. *Theca lutein cysts* - **Theca lutein cysts** are usually **asymptomatic** and benign, often resolving spontaneously. - Although associated with high **hCG levels**, they typically do not cause the acute, severe systemic symptoms like dyspnea and reduced urine output seen in this patient. *Ruptured corpus luteum cyst* - A **ruptured corpus luteum cyst** can cause sudden abdominal pain due to **hemoperitoneum**, but it usually does not lead to severe systemic symptoms like significant dyspnea or reduced urine output unless there is massive hemorrhage. - The clinical picture with **dyspnea** and **reduced urine output** points more towards systemic fluid shifts rather than localized bleeding alone.
Question 28: A female patient presents with multiple sessile lesions on the vulva that do not bleed on touch. What is the most likely diagnosis?
- A. Molluscum
- B. Condyloma acuminata (Correct Answer)
- C. Herpes genitalis
- D. Chancroid
Explanation: ***Condyloma acuminata*** - **Condyloma acuminata**, also known as genital warts, are typically **sessile or pedunculated lesions** with a verrucous (cauliflower-like) appearance, commonly found on the vulva. - These lesions are caused by the **human papillomavirus (HPV)** and generally do not bleed on touch unless traumatized. *Molluscum* - **Molluscum contagiosum** presents as **dome-shaped, pearly papules** with a central umbilication, not sessile lesions. - The lesions are typically smaller and have a characteristic central dimple. *Herpes genitalis* - **Herpes genitalis** presents as painful **vesicles or ulcers** that often rupture and form crusts, not sessile lesions. - These lesions are typically accompanied by pain and itching. *Chancroid* - **Chancroid** is characterized by one or more **painful, soft chancres** with irregular, undermined borders and a grayish base that often bleeds easily. - Ulcers are the hallmark of chancroid, not sessile growths.
Question 29: 24 yr old mother with 7 week POG presents to ANC OPD with accidental low-dose radiation exposure. What is the most appropriate immediate management?
- A. Reassure and continue pregnancy (Correct Answer)
- B. Perform detailed fetal anomaly scan
- C. Advise medical termination of pregnancy
- D. Advise genetic counseling and testing
Explanation: ***Reassure and continue pregnancy*** - **Low-dose radiation exposure** (typically defined as <50 mGy) during pregnancy is generally associated with a very low risk of fetal anomalies or adverse outcomes. The patient should be reassured that the risk to the fetus is minimal. - The threshold for concern for teratogenic effects from radiation is significantly higher than a low dose, and **medical termination of pregnancy** is not indicated in such cases. - This is the most appropriate **immediate management** for accidental low-dose radiation exposure at 7 weeks gestation. *Perform detailed fetal anomaly scan* - While anomaly scans are part of routine prenatal care, performing an immediate, detailed scan solely due to **low-dose radiation exposure** at 7 weeks is not the most appropriate *immediate* management. The risk of anomalies from such exposure is extremely low and unlikely to be detectable at 7 weeks. - A more detailed scan may be considered at later gestational ages (e.g., 18-20 weeks) as part of standard care, but not as an emergency response to low-dose exposure. *Advise medical termination of pregnancy* - Medical termination is **not indicated** for accidental **low-dose radiation exposure**. Termination is only considered in cases of *extremely high* and confirmed doses (e.g., >100 mGy), which carry a significant risk of severe fetal anomalies or mortality. - Such high doses are rare in accidental exposures and would necessitate a thorough dose assessment by a radiation physicist before considering any drastic measures. - Since the scenario specifies low-dose exposure, termination would be inappropriate and potentially harmful counseling. *Advise genetic counseling and testing* - **Genetic counseling** and testing would be indicated for known genetic risks, advanced maternal age, or suspicion of chromosomal abnormalities, none of which are suggested by accidental **low-dose radiation exposure**. - Radiation-induced effects are typically teratogenic rather than directly causing inheritable genetic mutations that would be detected by standard genetic testing.