A 20 year old woman presented at 7 weeks of gestation, unwilling to continue the pregnancy. What are the drugs used for medical termination of pregnancy in this patient?
An intrauterine scan at the 13th week of pregnancy showed a fetus with multiple long bone fractures. What is commonly associated with this finding?
What will be the level of the uterus on the second day post delivery?
A 20 year old woman is evaluated for primary infertility. Hysterosalpingography was done and reveals an anomaly. What is the anomaly seen in the image?
Which of the following is NOT an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?
A primigravida at 22 weeks of gestation presents with profuse vaginal bleeding. Her blood pressure and glucose levels are normal. At which of the following sites can placental implantation lead to this condition?
A female patient collapses soon after delivery. There is profuse bleeding and features of disseminated intravascular coagulation. Which of the following is the most likely etiology?
A female patient presents to you with six weeks of amenorrhea, associated with abdominal pain and vaginal bleeding with normal blood pressure. Investigations revealed beta-hCG to be 1400 mIU/mL. An ultrasound scan was done which showed a trilaminar endometrium with normal adnexa. What is the next best step in the management of this patient?
A couple comes for evaluation of infertility. The HSG was normal but semen analysis revealed azoospermia. What is the diagnostic test to differentiate between testicular failure and vas deferens obstruction?
Hymenal tear following first sexual intercourse most commonly occurs at which position:
NEET-PG 2022 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 11: A 20 year old woman presented at 7 weeks of gestation, unwilling to continue the pregnancy. What are the drugs used for medical termination of pregnancy in this patient?
- A. Misoprostol and Mifepristone (Correct Answer)
- B. Misoprostol and Medroxyprogesterone
- C. Mifepristone and Medroxyprogesterone
- D. Mifepristone and Methotrexate
Explanation: ***Misoprostol and Mifepristone*** - This combination is the **standard and most effective medical regimen** for termination of pregnancy in the first trimester (up to 9-10 weeks). - **Mifepristone** (200mg) is an **antiprogestin** that blocks progesterone receptors, essential for maintaining pregnancy, followed 24-48 hours later by **Misoprostol** (800mcg), a **prostaglandin analog** that causes cervical ripening and strong uterine contractions. - This regimen has a **95-98% success rate** and is the WHO-recommended protocol. *Misoprostol and Medroxyprogesterone* - **Medroxyprogesterone** is a **progestin**, which would **support and maintain pregnancy** rather than terminate it, making this combination ineffective for medical abortion. - Medroxyprogesterone is used for contraception and menstrual regulation, not pregnancy termination. *Mifepristone and Medroxyprogesterone* - **Medroxyprogesterone** is a progestin and would **directly antagonize the antiprogestin action of Mifepristone**, preventing pregnancy termination. - This combination is pharmacologically contradictory and would not achieve abortion. *Mifepristone and Methotrexate* - **Mifepristone and Methotrexate are not used together** in medical abortion protocols. - **Methotrexate** (antimetabolite) is occasionally used with **Misoprostol** (not Mifepristone) as an alternative regimen, but it is much slower (7-14 days vs 24-48 hours), less effective, and primarily reserved for ectopic pregnancy management. - The standard combination for intrauterine pregnancy termination is Mifepristone + Misoprostol, not Mifepristone + Methotrexate.
Question 12: An intrauterine scan at the 13th week of pregnancy showed a fetus with multiple long bone fractures. What is commonly associated with this finding?
- A. Osteogenesis imperfecta (Correct Answer)
- B. Marfan syndrome
- C. Achondroplasia
- D. Cretinism
Explanation: ***Osteogenesis imperfecta*** - **Multiple long bone fractures** detected early in pregnancy are a classic presentation of **osteogenesis imperfecta (OI)**, a genetic disorder characterized by **bone fragility**. - OI is primarily caused by mutations in genes encoding **type I collagen**, leading to defective bone formation. *Achondroplasia* - This condition is a form of **dwarfism** characterized by disproportionately short limbs and a normal-sized trunk, resulting from a mutation in the **FGFR3 gene**. - While it affects bone growth, it typically does not cause **multiple fractures** prenatally. *Marfan syndrome* - This is a connective tissue disorder affecting the skeletal, ocular, and cardiovascular systems, characterized by **tall stature**, **long limbs and fingers**, and **aortic root dilation**. - It results from a mutation in the **fibrillin-1 gene** and is not primarily associated with prenatal long bone fractures. *Cretinism* - This is a historical term for **congenital hypothyroidism**, which results from severely deficient thyroid hormone production in a newborn. - It leads to developmental delays, growth retardation, and intellectual disability, but not to **multiple bone fractures**.
Question 13: What will be the level of the uterus on the second day post delivery?
- A. One finger breadth below umbilicus (Correct Answer)
- B. Two finger breadths below umbilicus
- C. Three finger breadths below umbilicus
- D. Four finger breadths below umbilicus
Explanation: ***One finger breadth below umbilicus*** - On the second day postpartum, the **fundus** is typically located approximately **one finger breadth below the umbilicus**. - This reflects the ongoing process of **involution**, where the uterus contracts and descends back into the pelvis. *Two finger breadths below umbilicus* - This level is usually observed around **day 3 or 4 postpartum**, as the uterus continues to involute. - The descent is gradual, making it less likely to be at this level on just the second day. *Three finger breadths below umbilicus* - This position is generally reached around **day 5 or 6 postpartum** as uterine involution progresses. - A uterus at this level on day 2 would suggest a more rapid than usual involution. *Four finger breadths below umbilicus* - This level is more consistent with the uterine position around **day 7 or 8 postpartum**. - On the second day, the uterus would still be considerably higher than this.
Question 14: A 20 year old woman is evaluated for primary infertility. Hysterosalpingography was done and reveals an anomaly. What is the anomaly seen in the image?
- A. Septate uterus (Correct Answer)
- B. Uterine didelphys
- C. Bicornuate uterus
- D. Unicornuate uterus
Explanation: ***Septate uterus*** - The image exhibits a **single uterine cavity** with a **septum** or indentation extending downwards, splitting the cavity into two distinct portions superiorly. - This configuration, particularly with an external contour that is typically **convex or flat**, is characteristic of a septate uterus, which is often associated with recurrent pregnancy loss and infertility. *Uterine didelphys* - This anomaly involves **two completely separate uteri**, each with its own cervix and often a separate vagina. - The image clearly shows a single main uterine body that then divides superiorly, not two entirely distinct uteri. *Bicornuate uterus* - A bicornuate uterus typically has two uterine horns that are **divergent externally**, creating a **deep indentation** on the external contour of the fundus. - While it also involves a divided uterine cavity, the external contour in the image appears more convex or flat, which is less consistent with a bicornuate uterus where the outer fundal contour is notably indented. *Unicornuate uterus* - This anomaly results from the **failure of one Müllerian duct to develop**, leading to a uterus that has only one horn and one fallopian tube. - The image presents a uterus with two distinct horns, ruling out a unicornuate uterus.
Question 15: Which of the following is NOT an absolute contraindication for the use of an Intra Uterine Contraceptive Device (IUD)?
- A. Uterine malformation (Correct Answer)
- B. Pregnancy
- C. Active pelvic infection
- D. Known allergy to IUD components
Explanation: ***Uterine malformation*** - While a **uterine malformation** can make IUD placement difficult or increase the risk of expulsion, it is generally considered a **relative contraindication**, not an absolute one. - The decision to place an IUD in such cases depends on the specific type of malformation and the experience of the clinician. *Pregnancy* - **Pregnancy** is an **absolute contraindication** because an IUD offers no protection against pregnancy in an already conceived state and can lead to complications such as miscarriage or ectopic pregnancy if inserted. - Inserting an IUD into a pregnant uterus can cause significant harm to both the mother and the fetus. *Active pelvic infection* - An **active pelvic infection** (e.g., **pelvic inflammatory disease, cervicitis**) is an **absolute contraindication** due to the risk of exacerbating the infection and spreading it further into the uterus and fallopian tubes. - IUD insertion during an active infection can lead to severe complications. *Known allergy to IUD components* - A **known allergy** to any component of the IUD (e.g., copper, plastic) is an **absolute contraindication** to avoid severe allergic reactions. - Allergic reactions can range from localized irritation to systemic responses.
Question 16: A primigravida at 22 weeks of gestation presents with profuse vaginal bleeding. Her blood pressure and glucose levels are normal. At which of the following sites can placental implantation lead to this condition?
- A. Over the internal cervical os (Correct Answer)
- B. In the fallopian tube
- C. On the ovary
- D. In the abdominal cavity
Explanation: ***Over the internal cervical os*** - Implantation over the **internal cervical os** leads to **placenta previa**, which is a common cause of **painless, profuse vaginal bleeding** in the second and third trimesters. - The bleeding occurs as the cervix begins to efface and dilate, detaching the abnormally implanted placenta. *In the fallopian tube* - Implantation in the fallopian tube is known as an **ectopic pregnancy**, typically presenting with **abdominal pain** and bleeding in the **first trimester**, often requiring surgical intervention. - This condition is unlikely to result in profuse vaginal bleeding at 22 weeks of gestation with normal blood pressure. *On the ovary* - **Ovarian pregnancy** is a rare form of ectopic pregnancy that occurs when a fertilized egg implants on the surface of the ovary. - It usually presents with symptoms in the **first trimester**, such as abdominal pain and light spotting, not profuse hemorrhage in the second trimester. *In the abdominal cavity* - **Abdominal pregnancy** is another type of ectopic pregnancy where the fertilized egg implants in the abdominal cavity. - While it can lead to complications such as bleeding and abdominal pain, it is not typically associated with profuse vaginal bleeding as described for a 22-week gestation.
Question 17: A female patient collapses soon after delivery. There is profuse bleeding and features of disseminated intravascular coagulation. Which of the following is the most likely etiology?
- A. Uterine atony
- B. Peripartum cardiomyopathy
- C. Rupture of the uterus during delivery
- D. Amniotic fluid embolism (Correct Answer)
Explanation: ***Amniotic fluid embolism as a complication of pregnancy*** - **Amniotic fluid embolism** is a rare but catastrophic complication where amniotic fluid enters the maternal circulation, leading to sudden **cardiovascular collapse**, **respiratory distress**, and **disseminated intravascular coagulation (DIC)**. - The rapid onset of symptoms after delivery, along with profuse bleeding and features of DIC, is highly characteristic of this condition. *Uterine atony* - **Uterine atony** is the most common cause of **postpartum hemorrhage**, typically leading to profuse bleeding due to the uterus's inability to contract. - While it causes significant bleeding, it does not typically cause the triad of sudden cardiovascular collapse, respiratory distress, and DIC seen in amniotic fluid embolism. *Peripartum cardiomyopathy as a cause of collapse* - **Peripartum cardiomyopathy** can lead to heart failure and cardiovascular collapse, but it typically develops **gradually** in the peripartum period. - It does not directly cause profuse bleeding or DIC; rather, its complications might include thromboembolic events, which are distinct from the primary events described. *Rupture of the uterus during delivery* - **Uterine rupture** causes significant hemorrhage and can lead to maternal collapse. - However, it primarily results in **external or internal bleeding** from the rupture site and does not typically trigger the widespread systemic inflammatory response and DIC as rapidly or profoundly as an amniotic fluid embolism.
Question 18: A female patient presents to you with six weeks of amenorrhea, associated with abdominal pain and vaginal bleeding with normal blood pressure. Investigations revealed beta-hCG to be 1400 mIU/mL. An ultrasound scan was done which showed a trilaminar endometrium with normal adnexa. What is the next best step in the management of this patient?
- A. Repeat beta – hCG after 48 hours (Correct Answer)
- B. Laparoscopy
- C. Repeat ultrasound after 5 days
- D. Measurement of serum progesterone
Explanation: ***Repeat beta – hCG after 48 hours*** - With a beta-hCG of 1400 mIU/mL and no intrauterine pregnancy visible on ultrasound, repeating **beta-hCG after 48 hours** is crucial to assess its doubling time, which helps differentiate between a normal intrauterine pregnancy, ectopic pregnancy, or miscarriage. - An hCG level of 1400 mIU/mL is below the discriminatory zone (typically 1500-2000 mIU/mL) where an intrauterine gestational sac should be visible, making serial measurements essential. *Repeat ultrasound after 5 days* - While a repeat ultrasound may eventually be necessary, waiting 5 days without an interim hCG measurement could delay diagnosis and management, especially if the hCG levels are rising rapidly or are in a concerning range. - The current beta-hCG level is below the **discriminatory zone**, meaning a gestational sac would likely still not be visible even after 5 days, making hCG follow-up a more immediate and informative step. *Measurement of serum progesterone* - **Serum progesterone** levels can indicate overall pregnancy viability, but they do not specifically localize the pregnancy or differentiate between an intrauterine pregnancy and an ectopic pregnancy as effectively as serial hCG levels. - A single low progesterone level could indicate a non-viable pregnancy (either intrauterine or ectopic), but it does not guide immediate management for distinguishing between locations. *Laparoscopy* - **Laparoscopy** is an invasive surgical procedure and is not the first diagnostic step unless there are signs of ruptured ectopic pregnancy or hemodynamic instability, which are not present in this patient (normal blood pressure, mild symptoms). - It would be premature to proceed with laparoscopy without further biochemical or sonographic evidence of an ectopic pregnancy or clear signs of clinical deterioration.
Question 19: A couple comes for evaluation of infertility. The HSG was normal but semen analysis revealed azoospermia. What is the diagnostic test to differentiate between testicular failure and vas deferens obstruction?
- A. Serum FSH (Correct Answer)
- B. Testicular FNAC
- C. Testosterone levels
- D. Karyotyping
Explanation: ***Serum FSH*** - In **testicular failure**, the pituitary gland tries to compensate for poor sperm production by increasing **follicle-stimulating hormone (FSH)**, leading to **elevated FSH levels**. - In **vas deferens obstruction**, the testes are producing sperm normally, so the pituitary does not need to overstimulate them, resulting in **normal FSH levels**. *Testicular FNAC* - **Fine needle aspiration cytology (FNAC)** of the testis can *confirm* the presence or absence of sperm production but is not the primary diagnostic test to *differentiate* between the two conditions without prior hormonal assessment. - It is an **invasive procedure** typically considered after initial hormone testing and physical examination. *Testosterone levels* - **Testosterone levels** primarily reflect the Leydig cell function and can be normal in both **testicular failure** (especially germ cell-specific failure) and **vas deferens obstruction**. - While low testosterone can indicate Leydig cell dysfunction, it doesn't specifically differentiate between the two causes of azoospermia in all cases. *Karyotyping* - **Karyotyping** is used to detect **chromosomal abnormalities** (e.g., Klinefelter syndrome) that can cause testicular failure. - While important for identifying underlying genetic causes, it does not directly differentiate between existing testicular failure and vas deferens obstruction based on direct physiological function.
Question 20: Hymenal tear following first sexual intercourse most commonly occurs at which position:
- A. 11 o'clock
- B. 6 o'clock (Correct Answer)
- C. 12 o'clock
- D. All of the above
Explanation: ***Correct: 6 o'clock*** - The **hymen** is most commonly torn at the **6 o'clock position** (inferiorly) due to the direction of typical coital forces during first intercourse. - This area is usually the **thinnest** and **least supported**, making it more susceptible to tearing during initial penetration. - This is the most consistently reported site for initial hymenal tears in forensic and gynecological literature. *Incorrect: 11 o'clock* - While hymenal tears can occur at other positions, the **11 o'clock position** is not the most common site of rupture during first intercourse. - Tears at superior or lateral positions are less frequent unless there are unusual circumstances or anatomical variations. *Incorrect: 12 o'clock* - The **12 o'clock position** (superiorly) is less commonly the primary site of hymenal rupture during first intercourse. - The majority of tears are observed inferiorly (at 6 o'clock) due to the anatomy and mechanics of penetration. *Incorrect: All of the above* - While it is possible for the hymen to tear at **multiple positions** or in various configurations, the question asks for the *most common* position. - The 6 o'clock position is the most consistently reported site for initial hymenal tears, not all positions equally.