OB/GYN
5 questionsA 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?
NEET-PG 2021 - OB/GYN NEET-PG Practice Questions and MCQs
Question 141: 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 142: 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 143: 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 144: 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 145: 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.
Obstetrics and Gynecology
5 questionsA 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?
A woman presents with a history of recurrent abortions at 8,11 , and 22 weeks, with normal fetal cardiac activity in all three pregnancies. She also has a history of preeclampsia in her last pregnancy. What is the most probable cause?
NEET-PG 2021 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 141: 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 142: 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 143: 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 144: 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.
Question 145: A woman presents with a history of recurrent abortions at 8,11 , and 22 weeks, with normal fetal cardiac activity in all three pregnancies. She also has a history of preeclampsia in her last pregnancy. What is the most probable cause?
- A. Syphilis
- B. Gestational Diabetes Mellitus (GDM)
- C. TORCH infections
- D. Antiphospholipid Antibody Syndrome (APLA) (Correct Answer)
Explanation: ***Antiphospholipid Antibody Syndrome (APLA)*** - The presentation of **recurrent abortions** (especially with normal fetal cardiac activity) and a history of **preeclampsia** is highly characteristic of Antiphospholipid Antibody Syndrome (APLA). - In APLA, antibodies cause **thrombosis** in the placental vasculature, leading to placental insufficiency, fetal loss, and complications like preeclampsia. *Syphilis* - While syphilis can cause fetal loss, it typically presents with **hydrops fetalis**, hepatosplenomegaly, and bone abnormalities, rather than recurrent losses with normal cardiac activity in the early stages. - Untreated syphilis usually leads to congenital syphilis or stillbirths later in pregnancy, not necessarily early recurrent abortions with good fetal heart tones. *Gestational Diabetes Mellitus (GDM)* - GDM is associated with complications like **macrosomia**, polyhydramnios, and an increased risk of shoulder dystocia, but it is not a direct cause of recurrent early and mid-trimester abortions with normal fetal cardiac activity. - While poorly controlled diabetes can affect fetal development and pregnancy outcomes, it does not typically manifest as recurrent unexplained fetal demise with this specific presentation. *TORCH infections* - TORCH infections (Toxoplasmosis, Other [syphilis, varicella-zoster, parvovirus B19], Rubella, Cytomegalovirus, and Herpes simplex virus) can cause congenital anomalies and fetal death. - However, they would usually present with specific fetal abnormalities, signs of infection, or hydrops, and not typically with recurrent, apparently healthy fetal losses followed by preeclampsia, as often seen in APLA.