NEET-PG 2022 - Obstetrics and Gynecology Practice Questions

Q: A woman at 26 weeks of gestation presents for routine evaluation. On examination, fundal height corresponds to 24 weeks. Ultrasonography revealed decreased amniotic fluid. Which of the following conditions would have led to this presentation?

Renal agenesis. ***Renal agenesis*** - **Renal agenesis** directly leads to **oligohydramnios** (decreased amniotic fluid) because fetal urine is the primary contributor to amniotic fluid volume after 20 weeks of gestation. - This reduction in amniotic fluid subsequently causes a **smaller fundal height** than expected for gestational age. *Tracheoesophageal fistula* - A **tracheoesophageal fistula** is primarily associated with **polyhydramnios** (excessive amniotic fluid) due to the fetus's inability to properly swallow amniotic fluid. - It would not lead to decreased amniotic fluid or a reduced fundal height. *Cardiac abnormalities* - **Cardiac abnormalities** can cause various fetal complications but are not typically a direct cause of **oligohydramnios**. - While severe cardiac issues can indirectly impact fetal growth, they usually do not lead to a significant reduction in amniotic fluid volume. *Ureteral stricture* - A **ureteral stricture** would impair urine flow from the kidney to the bladder, causing **hydronephrosis** of the affected kidney. - While it affects the renal system, if the other kidney is functioning, it generally would not lead to widespread **oligohydramnios** or a significantly reduced fundal height.

Q: 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?

Amniotic fluid embolism. ***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.

Q: A woman with an obstetric score of G2P1 comes to the clinic at 14 weeks of gestation for her antenatal checkup. A uterine artery doppler was suggested by the doctor. What would it detect?

Risk of early-onset preeclampsia. **Risk of early-onset preeclampsia** - **Uterine artery Doppler** at 11-14 weeks of gestation is used to screen for **preeclampsia risk**, particularly **early-onset preeclampsia**, which is associated with impaired placental development. - An increased **pulsatility index (PI)** or presence of **bilateral notching** in the uterine arteries indicates high resistance to blood flow, suggesting a higher risk of developing this condition. *Risk of late-onset preeclampsia* - While uterine artery Doppler can indicate a general risk for preeclampsia, its predictive value is significantly lower for **late-onset preeclampsia** (after 34 weeks). - Late-onset preeclampsia often has different underlying causes, not solely related to abnormal **trophoblast invasion** detectable by early Doppler. *Risk of placenta accreta* - **Placenta accreta** is typically associated with previous **cesarean sections** or other uterine surgeries, leading to abnormal placental implantation. - It is diagnosed by the absence of a clear retroplacental hypoechoic zone and features such as **lacunae** on **ultrasound**, not primarily by uterine artery Doppler. *Fetal growth restriction risk* - Uterine artery Doppler at 11-14 weeks can offer some indication of **fetal growth restriction (FGR)** risk, particularly if severe and related to **placental insufficiency**. - However, the primary surveillance for FGR later in pregnancy often involves **umbilical artery Doppler** and fetal biometry, not solely early uterine artery Doppler.

Q: A pregnant patient, with a history of classical cesarean section in view of fetal growth retardation in the previous pregnancy, presents to you. She is currently at 35 weeks of gestation with breech presentation. What is the next step in management?

Cesarean section at 37 weeks. ***Cesarean section at 37 weeks*** - A history of **classical cesarean section** is an absolute contraindication to vaginal birth due to the high risk of **uterine rupture**. - Performing the cesarean section at 37 weeks, rather than waiting longer, minimizes the risk of spontaneous labor and rupture while ensuring fetal maturity. *Advice USG and visit after 2 weeks* - This option does not address the critical risk of **uterine rupture** due to the previous classical cesarean section. - Delaying definitive management by two weeks could increase the risk of spontaneous labor and associated complications. *Internal podalic version followed by vaginal delivery* - An **internal podalic version** is a procedure used to change fetal lie during labor, typically for the second twin, and it is **contraindicated** with a previous classical cesarean due to rupture risk. - Given the previous classical incision, a **vaginal delivery is unsafe** and should not be attempted. *External cephalic version at 36 weeks* - **External cephalic version (ECV)** is generally contraindicated in patients with a history of a **classical cesarean section** due to the increased risk of uterine rupture. - Even if successful, the patient would still require a cesarean section for delivery given the previous uterine scar.

Q: 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?

Repeat beta – hCG after 48 hours. ***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.

Q: 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?

Serum FSH. ***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.

Q: Among the following the plane of least pelvic dimension is:

Mid-cavity. ***Mid-cavity*** - The **mid-cavity** or **mid-pelvis** is the plane of smallest dimensions during labor, defined by the ischial spines laterally [1]. - This plane is crucial for determining if a fetus can successfully navigate the birth canal, as it represents the narrowest point [1]. *Inlet* - The **pelvic inlet** is the widest part of the pelvis and usually poses less of a restriction during the descent of the fetal head [1]. - It is bounded by the sacral promontory, arcuate line, pectineal line, and pubic crest [2]. *False pelvis* - The **false pelvis** is the upper, broader part of the pelvis and does not play a direct role in guiding the fetal head through the birth canal [1]. - Its boundaries are largely abdominal and do not define crucial dimensions for passage [2]. *Outlet* - The **pelvic outlet** is the final opening that the fetal head must pass through, and while its dimensions are important, the mid-cavity is generally the narrowest point. - Its dimensions are measured from the pubic arch to the tip of the coccyx [3].

Question 1

A woman at 26 weeks of gestation presents for routine evaluation. On examination, fundal height corresponds to 24 weeks. Ultrasonography revealed decreased amniotic fluid. Which of the following conditions would have led to this presentation?

Accepted Answer

Renal agenesis

Answer

Tracheoesophageal fistula

Answer

Cardiac abnormalities

Answer

Ureteral stricture

Question 2

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?

Accepted Answer

Amniotic fluid embolism

Answer

Uterine atony

Answer

Peripartum cardiomyopathy

Answer

Rupture of the uterus during delivery

Question 3

A woman with an obstetric score of G2P1 comes to the clinic at 14 weeks of gestation for her antenatal checkup. A uterine artery doppler was suggested by the doctor. What would it detect?

Accepted Answer

Risk of early-onset preeclampsia

Answer

Risk of late-onset preeclampsia

Answer

Risk of placenta accreta

Answer

Fetal growth restriction risk

Question 4

A pregnant patient, with a history of classical cesarean section in view of fetal growth retardation in the previous pregnancy, presents to you. She is currently at 35 weeks of gestation with breech presentation. What is the next step in management?

Accepted Answer

Cesarean section at 37 weeks

Answer

Advice USG and visit after 2 weeks

Answer

Internal podalic version followed by vaginal delivery

Answer

External cephalic version at 36 weeks

Question 5

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?

Accepted Answer

Repeat beta – hCG after 48 hours

Answer

Laparoscopy

Answer

Repeat ultrasound after 5 days

Answer

Measurement of serum progesterone

Question 6

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?

Accepted Answer

Serum FSH

Answer

Testicular FNAC

Answer

Testosterone levels

Answer

Karyotyping

Question 7

Among the following the plane of least pelvic dimension is:

Accepted Answer

Mid-cavity

Answer

Inlet

Answer

False pelvis

Answer

Outlet

NEET-PG 2022 — Obstetrics and Gynecology