NEET-PG 2021 — OB/GYN
11 Previous Year Questions with Answers & Explanations
An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from
A 27-year-old woman who delivered a female child 9 months ago presents with complaints of absent periods since childbirth. She has been using contraceptive methods for family planning. Her serum beta-hCG level is 4.9 mIU/ ml , prolactin level is $88 \mathrm{ng} / \mathrm{ml}$, and TSH is 3.8 $\mu \mathrm{IU} / \mathrm{ml}$. What is the most likely reason for her amenorrhea?
A patient presents with cannonball lesions in the lungs following a recent molar pregnancy evacuation. What is the most appropriate management?
A husband requests paternity testing for his twins. The results show that one twin is biologically his child, but the other twin is not. What is the most likely diagnosis?
A teenage patient presents with dysmenorrhea and chronic pelvic pain. Upon further investigation, she is found to have a transverse vaginal septum. What is the most likely diagnosis?
A 28-year-old married woman is anxious about conception and presents with complaints of profuse vaginal discharge. She has no history of itching. It has been 12 days since her last menstrual period (LMP). What is the most likely cause of her symptoms?
A female patient missed her oral contraceptive pill (OCP) on four different days during the first two weeks of her menstrual cycle. What is the most appropriate advice for her?
A 36-week pregnant woman with mitral stenosis has been on warfarin for anticoagulation. What is the most appropriate next step in her management?
A patient with second-degree cervical prolapse complains of dribbling of urine when coughing. What is the most likely diagnosis?
A 23-year-old primigravida lives in the same house as her school-going nephew, who contracted a varicella infection. The woman approached the medical center and was tested for varicella antibodies, with a negative result. Which of the following statements are true?
NEET-PG 2021 - OB/GYN NEET-PG Practice Questions and MCQs
Question 1: An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from
- A. Overflow incontinence
- B. Stress incontinence (Correct Answer)
- C. Urge incontinence
- D. Neurogenic bladder
Explanation: ***Stress incontinence*** - **Dribbling of urine** specifically with activities that increase intra-abdominal pressure like **coughing or straining** is the hallmark of stress incontinence. - This type of incontinence results from **weakness of the pelvic floor muscles** and/or intrinsic urethral sphincter deficiency. *Overflow incontinence* - This occurs when the bladder is **overfilled and unable to empty**, leading to constant dribbling or leakage. - Patients typically experience a **poor stream**, hesitancy, and a feeling of incomplete emptying, which are not described here. *Urge incontinence* - Characterized by a **sudden, strong urge to urinate** that is difficult to defer, often leading to involuntary leakage before reaching the toilet. - It is caused by **involuntary contractions of the detrusor muscle** and is not directly related to physical exertion like coughing. *Neurogenic bladder* - This refers to bladder dysfunction due to a **neurological condition** affecting bladder control, such as spinal cord injury or multiple sclerosis. - Symptoms can vary broadly (flaccid or spastic bladder) and are not limited to leakage with coughing alone.
Question 2: A 27-year-old woman who delivered a female child 9 months ago presents with complaints of absent periods since childbirth. She has been using contraceptive methods for family planning. Her serum beta-hCG level is 4.9 mIU/ ml , prolactin level is $88 \mathrm{ng} / \mathrm{ml}$, and TSH is 3.8 $\mu \mathrm{IU} / \mathrm{ml}$. What is the most likely reason for her amenorrhea?
- A. Lactational amenorrhea (Correct Answer)
- B. Hypothyroidism
- C. Prolactinoma
- D. Normal pregnancy
Explanation: ***Lactational amenorrhea*** - The patient describes a history of recent childbirth (9 months ago), amenorrhea, and an elevated **prolactin level** (**88 ng/mL**). - While contraceptive methods are being used, persistent **postpartum amenorrhea** with hyperprolactinemia is commonly seen in women who are breastfeeding, even if intermittently. *Hypothyroidism* - Although **hypothyroidism** can cause amenorrhea, the patient's TSH level of **3.8 μIU/mL** is within the normal reference range, making hypothyroidism an unlikely cause. - While mild thyroid dysfunction can impact menstrual cycles, this TSH level alone is not sufficient to explain **amenorrhea**. *Prolactinoma* - A **prolactinoma** is characterized by significantly elevated prolactin levels, often much higher than the **88 ng/mL** seen in this patient (typically > 100-200 ng/mL). - Given the recent childbirth, the elevated prolactin is more likely physiological due to lactation rather than a **pathological tumor**. *Normal pregnancy* - The patient's serum **beta-hCG level of 4.9 mIU/mL** is below the threshold typically considered diagnostic for pregnancy (usually >25 mIU/mL). - This value indicates that a **normal ongoing pregnancy** is highly unlikely.
Question 3: A patient presents with cannonball lesions in the lungs following a recent molar pregnancy evacuation. What is the most appropriate management?
- A. EMACO regimen (Correct Answer)
- B. Inj. Methotrexate
- C. Hysterectomy
- D. Multiple dose of Inj. Methotrexate
Explanation: ***EMACO regimen*** - The presence of **cannonball lesions** in the lungs after a molar pregnancy evacuation suggests **gestational trophoblastic neoplasia (GTN)**, specifically **choriocarcinoma** with pulmonary metastases. - The **EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine)** regimen is a highly effective multi-agent chemotherapy protocol for **high-risk GTN**, including metastatic disease. *Inj. Methotrexate* - Single-agent methotrexate is primarily used for **low-risk GTN** or as a single or double-dose regimen in specific cases of persistent GTN. - It is generally insufficient for **high-risk GTN** with pulmonary metastases, where more aggressive multi-agent chemotherapy is required. *Hysterectomy* - While hysterectomy can be an option in specific cases of **non-metastatic GTN**, especially for older patients desiring definitive treatment, it is not the primary treatment for **metastatic disease**. - Systemic chemotherapy is essential to address the widespread nature of metastatic gestational trophoblastic neoplasia. *Multiple dose of Inj. Methotrexate* - Multiple doses of methotrexate might be considered for intermediate-risk GTN or as part of a multi-agent regimen, but it's often not sufficient as a sole agent for **high-risk metastatic disease** indicated by extensive pulmonary lesions. - The **EMACO regime** combines several powerful chemotherapeutic agents for a more comprehensive attack on advanced and metastatic GTN.
Question 4: A husband requests paternity testing for his twins. The results show that one twin is biologically his child, but the other twin is not. What is the most likely diagnosis?
- A. Superfetation
- B. Posthumous child
- C. Superfecundation (Correct Answer)
- D. None of the options
Explanation: ***Superfecundation*** - **Superfecundation** occurs when two separate eggs released in the same menstrual cycle are fertilized by sperm from **different sexual acts or different fathers**, leading to dizygotic twins from separate fathers. - This scenario specifically describes **heteropaternal superfecundation**, where twins are born to one mother but have different biological fathers, making it the most likely diagnosis. *Superfetation* - **Superfetation** refers to the rare phenomenon where a second, new pregnancy is established in a female already pregnant, resulting in fetuses of **different gestational ages**. - This condition is unlikely here as the twins are presumably of similar gestational age, and the issue is paternity, not sequential pregnancies. *Posthumous child* - A **posthumous child** is one born after the death of its father; this term refers solely to the father's marital status at the time of birth or conception, not to the biological paternity of the child as tested. - This option does not explain how one twin could have a different biological father. *None of the options* - This option is incorrect because **superfecundation** accurately describes the phenomenon where twins of the same mother have different biological fathers due to fertilization by sperm from two different partners.
Question 5: A teenage patient presents with dysmenorrhea and chronic pelvic pain. Upon further investigation, she is found to have a transverse vaginal septum. What is the most likely diagnosis?
- A. Dermoid cyst
- B. Tubo-ovarian abscess
- C. Endometriosis (Correct Answer)
- D. Hematocolpos/Hematometra
Explanation: ***Endometriosis*** - This condition is characterized by the presence of **endometrial-like tissue outside the uterus**, which responds to hormonal changes, leading to chronic pelvic pain and dysmenorrhea. - While a transverse vaginal septum isn't a direct cause of endometriosis, this presentation of chronic pain and dysmenorrhea in a teenager strongly suggests endometriosis, and the septum might be an incidental finding or a contributing factor to pain due to outflow obstruction in some cases. *Dermoid cyst* - A dermoid cyst (mature cystic teratoma) is a benign ovarian tumor that typically causes pelvic pain due to its size or torsion, and it does not usually cause dysmenorrhea. - It would not be directly associated with the presence of a transverse vaginal septum. *Tubo-ovarian abscess* - A tubo-ovarian abscess is an inflammatory mass involving the fallopian tube and ovary, typically presenting with acute-onset severe pelvic pain, fever, and leukocytosis. - While it causes pelvic pain, it is usually acute and infectious in nature, and not inherently linked to dysmenorrhea or a transverse vaginal septum. *Hematocolpos/Hematometra* - **Hematocolpos** (blood in the vagina) or **hematometra** (blood in the uterus) results from an outflow obstruction, such as an imperforate hymen or a transverse vaginal septum. - While a transverse vaginal septum could lead to hematocolpos, the primary symptoms would be cyclical abdominal pain progressing from menarche, an abdominal mass, and **amenorrhea** (absence of menstruation), rather than dysmenorrhea (painful menstruation) which implies some menstrual flow.
Question 6: A 28-year-old married woman is anxious about conception and presents with complaints of profuse vaginal discharge. She has no history of itching. It has been 12 days since her last menstrual period (LMP). What is the most likely cause of her symptoms?
- A. Candida
- B. Trichomonas
- C. Physiological (Correct Answer)
- D. Bacterial vaginosis
Explanation: ***Physiological*** - **Physiological vaginal discharge** at mid-cycle (12 days post-LMP) is common and normal, often becoming profuse, clear, and elastic, indicating **ovulation**. - The absence of **itching** or other bothersome symptoms supports a non-pathological cause, especially given her anxiety about conception. *Candida* - **Candidal infections** typically present with a **thick, white, curdy discharge** and are characteristically associated with intense **itching**, which is absent in this case. - The discharge is usually not described as profuse or clear. *Trichomonas* - **Trichomoniasis** is associated with a **frothy, greenish-yellow discharge** and often causes **vaginal itching**, **burning**, and a **foul odor**, none of which are described. - While discharge can be profuse, the clinical picture does not align with Trichomonas. *Bacterial vaginosis* - **Bacterial vaginosis** typically presents with a **thin, grayish-white discharge** and a characteristic **"fishy" odor**, especially after intercourse. - **Itching** is less common than with Candida, but the discharge characteristics and the timing relative to ovulation do not fit this diagnosis.
Question 7: A female patient missed her oral contraceptive pill (OCP) on four different days during the first two weeks of her menstrual cycle. What is the most appropriate advice for her?
- A. Adopt another method of contraception
- B. Continue taking the pill
- C. Continue current pack, consider additional contraceptive method for remaining days (Correct Answer)
- D. Take all 4 pills at once and continue taking pills
Explanation: **Continue current pack, consider additional contraceptive method for remaining days** - Missing four pills in the first two weeks significantly compromises contraceptive efficacy, necessitating the use of **backup contraception** (like condoms) for the remainder of the cycle. - Continuing the current pack is important to maintain hormonal rhythm and prevent unscheduled bleeding, but it won't immediately restore full protection. *Adopt another method of contraception* - While a backup method is needed, she doesn't necessarily need to **completely abandon** OCPs, especially if she has previously tolerated them well. - The immediate concern is the current cycle's protection; a long-term change in method might be considered if adherence is a persistent issue. *Continue taking the pill* - Simply continuing the pill without additional measures is **insufficient** as the contraceptive effectiveness has been significantly compromised by missing multiple doses. - This approach would leave her at a **high risk of pregnancy** during the current cycle. *Take all 4 pills at once and continue taking pills* - Taking multiple missed pills at once is **not recommended** and can lead to **nausea, vomiting**, or irregular bleeding due to a sudden high dose of hormones. - This strategy would not restore contraceptive efficacy effectively and would increase side effects without providing better protection.
Question 8: A 36-week pregnant woman with mitral stenosis has been on warfarin for anticoagulation. What is the most appropriate next step in her management?
- A. Continue Warfarin
- B. Aspirin + Heparin
- C. Shift to Low Molecular Weight (LMW) Heparin (Correct Answer)
- D. Switch to Aspirin
Explanation: ***Shift to Low Molecular Weight (LMW) Heparin*** - At 36 weeks gestation, **warfarin is contraindicated** due to its teratogenic effects and increased risk of **fetal bleeding**, especially during labor and delivery. - **LMW heparin** does not cross the placenta, making it a safer option for both mother and fetus in late pregnancy, and it can be discontinued prior to delivery to reduce bleeding risk. *Continue Warfarin* - Continuing warfarin at 36 weeks could lead to **fetal warfarin syndrome** if exposure occurred earlier, and significantly increases the risk of **fetal intracranial hemorrhage** during labor. - Warfarin has a narrow therapeutic window and requires close monitoring, making it less practical for ensuring fetal safety during an unpredictable labor and delivery. *Aspirin + Heparin* - While heparin is appropriate, the addition of **aspirin** to anticoagulation in a patient already on warfarin for mitral stenosis does not provide significant additional benefit and could **increase bleeding risk**. - **Unfractionated heparin (UFH)** is generally preferred over LMWH for patients requiring rapid reversal or close monitoring around delivery. *Switch to Aspirin* - **Aspirin alone is insufficient** for anticoagulation in a pregnant woman with mitral stenosis who has been on warfarin, as it does not adequately prevent thromboembolic events. - Mitral stenosis carries a high risk of **thrombus formation** and systemic embolization, necessitating more potent anticoagulation than aspirin provides.
Question 9: A patient with second-degree cervical prolapse complains of dribbling of urine when coughing. What is the most likely diagnosis?
- A. Cystitis
- B. Stress incontinence (Correct Answer)
- C. Overflow incontinence
- D. Functional incontinence
Explanation: ***Stress incontinence*** - **Stress incontinence** is characterized by involuntary urine leakage due to increased intra-abdominal pressure (e.g., coughing, sneezing), which is common in association with **pelvic organ prolapse** like a second-degree cervical prolapse. - The prolapse weakens the **pelvic floor muscles** and supporting structures around the urethra, diminishing its ability to maintain closure during sudden pressure changes. *Cystitis* - **Cystitis** is an inflammation of the bladder, typically presenting with symptoms like painful urination (dysuria), frequent urination, and urgency. - While it can cause bladder irritation, it does not directly lead to urine dribbling with coughing in the absence of other typical infection symptoms. *Overflow incontinence* - **Overflow incontinence** occurs due to an **overfilled bladder** that can't empty completely, leading to constant dribbling or leakage. - This typically results from a **bladder outlet obstruction** or an **underactive detrusor muscle**, not directly from increased abdominal pressure during coughing. *Functional incontinence* - **Functional incontinence** is when a person has control over their bladder but cannot reach the toilet in time due to **physical or cognitive impairments**. - It does not involve a problem with the urinary tract itself but rather with the ability to respond to the urge to urinate.
Question 10: A 23-year-old primigravida lives in the same house as her school-going nephew, who contracted a varicella infection. The woman approached the medical center and was tested for varicella antibodies, with a negative result. Which of the following statements are true?
- A. She is susceptible to zoster
- B. She is immune to chickenpox
- C. She is susceptible to chickenpox (Correct Answer)
- D. She is immune to zoster
Explanation: ***She is susceptible to chickenpox*** - A **negative varicella antibody test** indicates she has not previously been exposed to the **varicella-zoster virus (VZV)** and therefore lacks protective immunity. - As a **primigravida** living with an actively infected individual, she is at high risk of contracting primary chickenpox due to her susceptible status. *She is susceptible to zoster* - **Zoster (shingles)** is caused by the **reactivation of latent VZV** from a previous chickenpox infection, which she has not had. - Without a prior chickenpox infection, there is no dormant virus to reactivate, so susceptibility to zoster is not applicable. *She is immune to chickenpox* - **Immunity to chickenpox** is conferred by prior infection or vaccination, which would result in a **positive varicella antibody test**. - Her **negative antibody test** directly refutes the claim of immunity. *She is immune to zoster* - **Immunity to zoster** is not a primary concept; rather, zoster develops from the reactivation of latent VZV after a primary infection with chickenpox. - Since she is susceptible to chickenpox, she cannot be immune to zoster, which requires prior infection.