NEET-PG 2020 - Obstetrics and Gynecology Practice Questions

Q: A 7-week pregnant lady underwent a chest X-ray by mistake. What is to be done?

Reassure the patient and continue the pregnancy.. **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.

Q: 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?

Hysteroscopic surgery. ***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.

Q: In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

Middle cerebral artery Doppler wave forms. ***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.

Q: Which of the following is NOT used as an emergency contraceptive?

Danazol. ***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.

Q: Episotomy extended posteriorly beyond perineal body injuring structure posterior to it, which structure is injured?

External anal sphincter. ***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.

Q: 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?

Ovarian hyperstimulation syndrome. ***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.

Q: A female patient presents with multiple sessile lesions on the vulva that do not bleed on touch. What is the most likely diagnosis?

Condyloma acuminata. ***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 1

Which of the following cannot be used as Post-coital contraceptive?

Accepted Answer

A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol)

Answer

A device that prevents fertilization and implantation (e.g., CuT 200)

Answer

A hormonal method that disrupts ovulation (e.g., high-dose estrogens)

Answer

A progesterone receptor blocker used within 72 hours (e.g., RU 486)

Question 2

A 7-week pregnant lady underwent a chest X-ray by mistake. What is to be done?

Accepted Answer

Reassure the patient and continue the pregnancy.

Answer

Terminate the pregnancy immediately due to radiation exposure.

Answer

Perform chromosomal testing to assess fetal damage.

Answer

Conduct prenatal invasive diagnostic tests to evaluate fetal health.

Question 3

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?

Accepted Answer

Hysteroscopic surgery

Answer

Tompkins procedure

Answer

Jones procedure

Answer

Strassman procedure

Question 4

In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

Accepted Answer

Middle cerebral artery Doppler wave forms

Answer

Biophysical profile

Answer

Amniotic fluid spectrophotometry

Answer

Fetal blood sampling

Question 5

Which of the following is NOT used as an emergency contraceptive?

Accepted Answer

Danazol

Answer

RU 486

Answer

Copper T

Answer

OCpill

Question 6

Episotomy extended posteriorly beyond perineal body injuring structure posterior to it, which structure is injured?

Accepted Answer

External anal sphincter

Answer

Urethral sphincter

Answer

Ischiocavernosus

Answer

Bulbospongiosus

Question 7

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?

Accepted Answer

Ovarian hyperstimulation syndrome

Answer

Ruptured ectopic pregnancy

Answer

Ruptured corpus luteum cyst

Answer

Theca lutein cysts

Question 8

A female patient presents with multiple sessile lesions on the vulva that do not bleed on touch. What is the most likely diagnosis?

Accepted Answer

Condyloma acuminata

Answer

Molluscum

Answer

Herpes genitalis

Answer

Chancroid

Question 9

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?

Accepted Answer

Reassure and continue pregnancy

Answer

Perform detailed fetal anomaly scan

Answer

Advise medical termination of pregnancy

Answer

Advise genetic counseling and testing

NEET-PG 2020 — Obstetrics and Gynecology