NEET-PG 2021 — Obstetrics and Gynecology
12 Previous Year Questions with Answers & Explanations
A pregnant woman, whose niece contracted varicella while living in the same house, tested negative for serum antibodies to varicella. What does this result indicate?
A pregnant woman comes for a routine antenatal checkup. She had a history of a twin pregnancy one year ago. What is her gravida and para status?
Which of the following is NOT typically associated with uterine didelphys?
What is the preferred management of a uterine septum?
A woman with a history of primary infertility is found to have two fibroids in the cornual region and bilateral tubal blockage, with normal ovulation and semen analysis. What is the most appropriate treatment?
A 24-year-old female patient presents with a few weeks of amenorrhea, a left adnexal mass on ultrasound, and a beta-hCG level of $2500 \mathrm{mIU} / \mathrm{mL}$. No fetal heart rate is detected on the ultrasound. What is the most appropriate management?
A woman has been using oral contraceptive pills (OCP) for 5 months and has had amenorrhea for the last 6 weeks. What is the best method to calculate the gestational age in this case?
What is the correct order of ligation for devascularization in the management of Postpartum Hemorrhage (PPH)?
A pregnant female presents with active herpetic lesions on the vulva. What is the most appropriate management?
A patient presents with infraumbilical flattening and the fetal heart rate is heard laterally. What is the most likely fetal position?
NEET-PG 2021 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1: A pregnant woman, whose niece contracted varicella while living in the same house, tested negative for serum antibodies to varicella. What does this result indicate?
- A. She is susceptible to zoster
- B. She is immune to zoster
- C. She is immune to chicken pox
- D. She is susceptible to chickenpox (Correct Answer)
Explanation: ***She is susceptible to chickenpox*** - A negative test for serum antibodies to varicella indicates a **lack of protective immunity** to the varicella-zoster virus (VZV). - This woman has not previously been infected with VZV or vaccinated, making her **susceptible to primary infection (chickenpox)** upon exposure. *She is susceptible to zoster* - **Zoster (shingles)** is caused by the **reactivation of latent VZV** in individuals who have previously had chickenpox. - Since she tested negative for antibodies, she has not had chickenpox and thus **cannot harbor latent VZV** to reactivate. *She is immune to zoster* - Immunity to zoster implies that she has had chickenpox and subsequently developed a robust immune response to prevent viral reactivation. - A negative antibody test directly contradicts this, as it signifies no prior exposure or immune response. *She is immune to chicken pox* - Immunity to chickenpox is established by the presence of **varicella antibodies**, which are absent in this case. - A negative antibody result means she is **not immune** and is therefore at risk of contracting chickenpox if exposed.
Question 2: A pregnant woman comes for a routine antenatal checkup. She had a history of a twin pregnancy one year ago. What is her gravida and para status?
- A. G2P1 (Correct Answer)
- B. G2P3
- C. G2P2
- D. G2P0
Explanation: ***G2P1*** - **Gravida (G)** refers to the total number of confirmed pregnancies, regardless of outcome. This current pregnancy is her second, making her G2. - **Para (P)** denotes the number of pregnancies that have reached viability (typically 20 weeks gestation or more), producing one or more fetuses. Her previous twin pregnancy, regardless of the number of babies, counts as one para event. *G2P3* - While G2 is correct (current pregnancy + previous twin pregnancy), P3 would imply three separate birth events beyond viability, which is not supported by the history of one twin pregnancy. - The number of babies born in a single pregnancy beyond viability does not increase the 'P' count; it refers to the number of pregnancies carried to term. *G2P2* - G2 is correct, but P2 would mean she had two separate pregnancies that reached viability. She only had one previous pregnancy that reached viability (the twin pregnancy). - The para count is determined by the number of deliveries, not the number of fetuses delivered. *G2P0* - While G2 is correct, P0 would mean she has never carried a pregnancy to the point of viability. - Her history clearly states a twin pregnancy one year ago, indicating a previous pregnancy carried to term, making P0 incorrect.
Question 3: Which of the following is NOT typically associated with uterine didelphys?
- A. Premature labor
- B. Endometriosis (Correct Answer)
- C. Transverse lie
- D. Repeated abortion
Explanation: ***Endometriosis*** - **Endometriosis** is a condition where tissue similar to the lining of the uterus grows outside the uterus; it is not typically associated with specific Müllerian anomalies like uterine didelphys. - While both conditions can cause pelvic pain or infertility, there isn't a direct causal link or increased prevalence of endometriosis specifically due to uterine didelphys. *Premature labor* - **Uterine didelphys** involves two separate uteri, each with its own cervix, which can lead to a smaller uterine cavity in each horn, increasing the risk of **premature labor**. - The abnormal uterine shape and reduced cavity size can compromise the ability to carry a pregnancy to term. *Transverse lie* - The presence of **two separate uterine horns** in uterine didelphys can significantly alter the shape of the uterine cavity, making it difficult for the fetus to assume a regular **longitudinal lie**. - This anatomical variation often predisposes to **malpresentation**, such as **transverse lie**, where the baby lies horizontally across the uterus. *Repeated abortion* - Uterine didelphys is associated with a higher incidence of **repeated abortions** due to various factors including the smaller size of each uterine cavity, potential cervical incompetence, and altered blood supply. - The structural abnormalities can prevent proper implantation or adequate growth of the fetus, leading to recurrent pregnancy losses.
Question 4: What is the preferred management of a uterine septum?
- A. Laparoscopic resection of septum
- B. Uterine metroplasty
- C. Laparotomy and resection
- D. Hysteroscopic resection of septum (Correct Answer)
Explanation: ***Hysteroscopic resection of septum*** - **Hysteroscopic resection of a uterine septum** is the preferred management due to its minimally invasive nature and high success rates in improving reproductive outcomes. - This procedure allows direct visualization and precise removal of the septal tissue, preserving the healthy uterine musculature. *Laparoscopic resection of septum* - While laparoscopic approaches are minimally invasive, directly resecting a uterine septum laparoscopically is generally **not the primary method**. - Laparoscopy is often used for diagnostics or in conjunction with hysteroscopy for guidance, but not typically for primary septal resection alone. *Uterine metroplasty* - **Uterine metroplasty** is a broader term for surgical reconstruction of the uterus, typically reserved for more complex uterine anomalies like a **bicornuate uterus**. - It involves more extensive surgical remodeling of the uterine cavity and is generally **more invasive** than hysteroscopic septal resection. *Laparotomy and resection* - **Laparotomy** involves a large abdominal incision and is a more invasive surgical approach with a longer recovery period. - It is generally **reserved for very complex uterine malformations** or cases where hysteroscopic or laparoscopic approaches are not feasible or have failed.
Question 5: A woman with a history of primary infertility is found to have two fibroids in the cornual region and bilateral tubal blockage, with normal ovulation and semen analysis. What is the most appropriate treatment?
- A. Laparoscopic Myomectomy
- B. Uterine Artery Embolization
- C. Hysterectomy
- D. Assisted Reproductive Technology (ART) (Correct Answer)
Explanation: ***Assisted Reproductive Technology (ART)*** - ART, specifically **in vitro fertilization (IVF)**, is the most appropriate treatment as it bypasses both the **tubal blockage** and the **cornual fibroids**, which can interfere with sperm transport and implantation, respectively. - While myomectomy could address the fibroids, it doesn't resolve the tubal blockage, making ART the most direct path to conception given the multifactorial infertility. *Laparoscopic Myomectomy* - This procedure would remove the **fibroids**, which may improve uterine receptivity and reduce potential pregnancy complications. - However, it would not address the **bilateral tubal blockage**, meaning natural conception would still be impossible without further intervention, making it less appropriate as a standalone treatment for primary infertility with multiple causes. *Uterine Artery Embolization* - **Uterine artery embolization (UAE)** is primarily used to manage symptoms of fibroids, such as bleeding and pain, and is generally **not recommended** for women desiring future fertility due to potential risks to ovarian function and uterine blood supply. - It also does not resolve the **tubal factor infertility**. *Hysterectomy* - **Hysterectomy** is the surgical removal of the uterus and is a definitive treatment for problematic fibroids. - However, it permanently **sterilizes** the patient and is therefore completely inappropriate for a woman desiring fertility.
Question 6: A 24-year-old female patient presents with a few weeks of amenorrhea, a left adnexal mass on ultrasound, and a beta-hCG level of $2500 \mathrm{mIU} / \mathrm{mL}$. No fetal heart rate is detected on the ultrasound. What is the most appropriate management?
- A. Expectant management
- B. Salpingectomy
- C. Milking of tube
- D. Single dose methotrexate (Correct Answer)
Explanation: **Single dose methotrexate** - A **beta-hCG level of 2500 mIU/mL** in conjunction with an adnexal mass and no fetal heart rate visible on ultrasound is consistent with an **unruptured ectopic pregnancy** in a hemodynamically stable patient. - **Methotrexate** is a systemic treatment that inhibits trophoblastic cell growth, leading to the resolution of the ectopic pregnancy without surgery. *Expectant management* - This approach is typically reserved for patients with very **low and declining beta-hCG levels** who are completely asymptomatic and have no evidence of rupture. - With a beta-hCG of 2500 mIU/mL and a definite adnexal mass, the risk of rupture is significant, making expectant management inappropriate. *Salpingectomy* - **Salpingectomy** (surgical removal of the fallopian tube) is usually indicated for **ruptured ectopic pregnancies**, hemodynamically unstable patients, or when medical management fails. - While it's an effective treatment, the patient's current presentation (unruptured, stable beta-hCG) allows for a less invasive medical approach first. *Milking of tube* - **"Milking" or "expressing" the tube** is an outdated and potentially harmful maneuver that involves squeezing the fallopian tube to push the ectopic pregnancy out. - This method is associated with **high rates of recurrence** and potential for tubal damage, and is not a recommended treatment for ectopic pregnancy.
Question 7: A woman has been using oral contraceptive pills (OCP) for 5 months and has had amenorrhea for the last 6 weeks. What is the best method to calculate the gestational age in this case?
- A. Abdominal girth
- B. 280 days from Last Menstrual Period (LMP)
- C. Crown-Rump Length (CRL) by Ultrasound (USG) (Correct Answer)
- D. 256 days from Last Menstrual Period (LMP)
Explanation: ***Crown-Rump Length (CRL) by Ultrasound (USG)*** - For women with **irregular menstrual cycles**, unknown last menstrual period, or those on **hormonal contraceptives**, **early ultrasound measurement of CRL** is the most accurate method for gestational age determination. - CRL is most accurate between **6 and 14 weeks of gestation**, providing a precise estimate within 3-5 days. *Abdominal girth* - **Abdominal girth** is an unreliable and highly variable measure that is not used for accurate gestational age determination. - It is influenced by maternal body habitus, uterine fibroids, and amniotic fluid volume, making it imprecise. *280 days from Last Menstrual Period (LMP)* - This method (Naegele's rule) assumes a **regular 28-day menstrual cycle** and ovulation on day 14, which is not applicable for a woman on **oral contraceptive pills (OCP)** where ovulation is suppressed. - The use of OCPs alters the hormonal profile, generally causing **amenorrhea or withdrawal bleeding** that does not reflect a true ovulatory cycle. *256 days from Last Menstrual Period (LMP)* - This calculation is not a standard or recognized method for determining **estimated date of delivery (EDD)**. - The standard calculation from LMP uses **280 days (40 weeks)** for a full-term pregnancy.
Question 8: What is the correct order of ligation for devascularization in the management of Postpartum Hemorrhage (PPH)?
- A. Uterine artery, internal iliac, obturator artery
- B. Uterine artery, pudendal artery, vaginal artery
- C. Uterine artery, ovarian artery, vaginal artery
- D. Uterine artery, ovarian artery, internal iliac artery (Correct Answer)
Explanation: ***Uterine artery, ovarian artery, internal iliac artery*** - Ligation of the **uterine artery** is typically the first step due to its primary role in supplying the uterus. It often resolves PPH. - If PPH persists, the next step is typically bilateral ligation of the **ovarian arteries**, followed by the **internal iliac arteries (hypogastric arteries)**. This sequence progressively reduces blood flow to the uterus while preserving collateral circulation as much as possible. *Uterine artery, internal iliac, obturator artery* - While initial ligation of the **uterine artery** is correct, the **obturator artery** is not a primary target for devascularization in PPH management. - The obturator artery mainly supplies the thigh and pelvic floor, and its ligation would not significantly impact uterine blood flow in the context of PPH. *Uterine artery, pudendal artery, vaginal artery* - **Uterine artery** ligation is appropriate, but the **pudendal artery** is not typically ligated for PPH; it supplies the perineum and external genitalia. - While the **vaginal artery** supplies part of the lower uterus and vagina, it is usually addressed after or in conjunction with the hypogastric arteries if uterine and ovarian vessel ligation is insufficient, and not before ovarian arteries. *Uterine artery, ovarian artery, vaginal artery* - Ligation of the **uterine artery** and **ovarian artery** is correct in sequence, but the **vaginal artery** alone is usually insufficient. - The next major supply to be considered if bleeding persists after uterine and ovarian ligation would be the **internal iliac artery** to address collateral supply from other branches, not just the vaginal artery in isolation.
Question 9: A pregnant female presents with active herpetic lesions on the vulva. What is the most appropriate management?
- A. Wait & watch
- B. Acyclovir & elective cesarean section (C-section) (Correct Answer)
- C. Acyclovir & allow spontaneous progression of labor
- D. Induction of labor
Explanation: ***Acyclovir & elective cesarean section (C-section)*** - Active **genital herpetic lesions** at the time of delivery pose a significant risk of transmitting **herpes simplex virus (HSV)** to the neonate. - **Acyclovir** can help suppress viral replication, but a **cesarean section** is necessary to prevent direct contact with the lesions during birth, which could lead to severe neonatal HSV infection. *Wait & watch* - This approach is inappropriate due to the high risk of **vertical transmission** of HSV to the neonate if lesions are active during vaginal delivery, potentially causing life-threatening complications. - **Neonatal HSV** can result in significant morbidity and mortality, including neurological damage and disseminated disease. *Acyclovir & allow spontaneous progression of labor* - While **acyclovir** can reduce viral load, it does not completely eliminate the risk of transmission from active lesions during a vaginal birth. - The primary concern is protecting the neonate from direct contact with the **active lesions** in the birth canal. *Induction of labor* - **Induction of labor** does not mitigate the risk of **vertical transmission** from active lesions during a vaginal delivery. - The focus should be on preventing contact with the lesions, not on expediting vaginal birth once active lesions are present.
Question 10: A patient presents with infraumbilical flattening and the fetal heart rate is heard laterally. What is the most likely fetal position?
- A. Occipitoposterior (Correct Answer)
- B. Right occipitoanterior
- C. Right dorsoanterior
- D. Left occipitoanterior
Explanation: ***Occipitoposterior*** - **Infraumbilical flattening** of the abdomen is a classic sign of an occipitoposterior position due to the fetal spine lying against the maternal spine. - The **heart sounds are heard laterally** because the fetal back, where the heart sounds are best transmitted, is positioned towards the maternal flanks. *Right occipitoanterior* - In a right occipitoanterior position, the fetal spine is anterior and slightly to the right, leading to a more **convex abdomen** and **heart sounds audible anteriorly** and to the right of the midline. - This position does not typically cause infraumbilical flattening. *Right dorsoanterior* - This term is more commonly associated with a **breech presentation** where the fetal back (dorsum) is anterior. - In a cephalic presentation, "dorsoanterior" is not a standard term for fetal position relative to the occiput. *Left occipitoanterior* - In a left occipitoanterior position, the fetal spine is anterior and slightly to the left, resulting in a **convex abdomen** and **heart sounds audible anteriorly** and to the left of the midline. - Infraumbilical flattening is not a characteristic finding for this position.