NEET-PG 2021 - OB/GYN PYQs Practice Questions

Q: An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from

Stress incontinence. ***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. [Practice more OB/GYN PYQs on OnCourse]

Q: 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?

Lactational amenorrhea. ***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. [Practice more OB/GYN PYQs on OnCourse]

Q: A patient presents with cannonball lesions in the lungs following a recent molar pregnancy evacuation. What is the most appropriate management?

EMACO regimen. ***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. [Practice more OB/GYN PYQs on OnCourse]

Q: 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?

Superfecundation. ***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. [Practice more OB/GYN PYQs on OnCourse]

Q: 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?

Endometriosis. ***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. [Practice more OB/GYN PYQs on OnCourse]

Question 1

An elderly female presented with dribbling of urine only on coughing and straining. What type of urinary incontinence is she suffering from

Accepted Answer

Stress incontinence

Answer

Overflow incontinence

Answer

Urge incontinence

Answer

Neurogenic bladder

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?

Accepted Answer

Lactational amenorrhea

Answer

Hypothyroidism

Answer

Prolactinoma

Answer

Normal pregnancy

Question 3

A patient presents with cannonball lesions in the lungs following a recent molar pregnancy evacuation. What is the most appropriate management?

Accepted Answer

EMACO regimen

Answer

Inj. Methotrexate

Answer

Hysterectomy

Answer

Multiple dose of Inj. Methotrexate

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?

Accepted Answer

Superfecundation

Answer

Superfetation

Answer

Posthumous child

Answer

None of the options

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?

Accepted Answer

Endometriosis

Answer

Dermoid cyst

Answer

Tubo-ovarian abscess

Answer

Hematocolpos/Hematometra

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?

Accepted Answer

Physiological

Answer

Candida

Answer

Trichomonas

Answer

Bacterial vaginosis

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?

Accepted Answer

Continue current pack, consider additional contraceptive method for remaining days

Answer

Adopt another method of contraception

Answer

Continue taking the pill

Answer

Take all 4 pills at once and continue taking pills

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?

Accepted Answer

Shift to Low Molecular Weight (LMW) Heparin

Answer

Continue Warfarin

Answer

Aspirin + Heparin

Answer

Switch to Aspirin

Question 9

A patient with second-degree cervical prolapse complains of dribbling of urine when coughing. What is the most likely diagnosis?

Accepted Answer

Stress incontinence

Answer

Cystitis

Answer

Overflow incontinence

Answer

Functional incontinence

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?

Accepted Answer

She is susceptible to chickenpox

Answer

She is susceptible to zoster

Answer

She is immune to chickenpox

Answer

She is immune to zoster

NEET-PG 2021 — OB/GYN