NEET-PG 2023 - Obstetrics and Gynecology PYQs Practice Questions

Q: A lady undergoes radical hysterectomy for suspected stage Ib cancer cervix. Histopathology reveals cancer extension to the lower part of the uterine body with positive surgical margins. What is the next step of management?

Chemoradiation. ***Correct Option: Chemoradiation*** - **Positive surgical margins** after radical hysterectomy represent a **high-risk feature** requiring adjuvant concurrent chemoradiation. - According to **GOG 109 trial** and **NCCN/ESGO guidelines**, high-risk features (positive surgical margins, parametrial involvement, or positive pelvic lymph nodes) mandate **concurrent chemoradiation** (external beam radiotherapy + cisplatin-based chemotherapy). - **Cisplatin-based chemoradiation** improves local control and overall survival compared to radiotherapy alone in high-risk post-operative cervical cancer. - The combination provides both local control (radiation) and systemic treatment (chemotherapy) to address micrometastatic disease. *Incorrect Option: Radiotherapy* - Radiotherapy alone is used for **intermediate-risk features** (large tumor size >4 cm, deep stromal invasion, lymphovascular space invasion) without positive margins or nodal involvement. - In this case with **positive surgical margins**, radiotherapy alone is insufficient and would miss the survival benefit provided by concurrent chemotherapy. - The presence of positive margins elevates this to high-risk category requiring combined modality treatment. *Incorrect Option: Chemotherapy* - Chemotherapy alone (without radiation) is not standard adjuvant treatment after radical hysterectomy. - Systemic chemotherapy as a single modality is reserved for recurrent or metastatic disease. - The standard in high-risk post-operative cases is **concurrent** chemoradiation, not sequential therapy. *Incorrect Option: Follow-up* - Follow-up alone is contraindicated with **positive surgical margins**, which indicate residual microscopic disease. - Without adjuvant treatment, the risk of local recurrence and distant metastasis is unacceptably high. - Active intervention with chemoradiation is essential to improve disease-free and overall survival. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Hysteroscopy is indicated in all of the following except:

Active pelvic infection. ***Active pelvic infection*** - An **active pelvic infection** is a **contraindication** to hysteroscopy due to the risk of exacerbating the infection and spreading it systemically. - Performing hysteroscopy in the presence of infection can lead to **sepsis** or worsening of pelvic inflammatory disease. *Asherman syndrome* - **Asherman syndrome**, characterized by **intrauterine adhesions**, is a common indication for hysteroscopy to diagnose and surgically resect the adhesions. - Hysteroscopy allows for direct visualization and **lysis of adhesions** to restore uterine cavity integrity. *Infertility* - **Infertility** is a frequent indication for hysteroscopy to evaluate the uterine cavity for **structural abnormalities** such as polyps, fibroids, or septa that might impede conception or implantation. - It helps in identifying and often correcting intrauterine pathologies that contribute to a woman's inability to conceive. *Misplaced intrauterine devices* - Hysteroscopy is indicated for the retrieval of **misplaced or embedded intrauterine devices (IUDs)**, especially if they cannot be removed by simpler methods. - It provides direct visualization of the uterine cavity to help locate and safely extract the IUD, preventing further complications. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A female presents with 6 weeks of amenorrhea, experiencing vaginal bleeding and slight abdominal pain. A urine pregnancy test is positive, and her hCG level is 2800 IU/L. A mass measuring 3 x 2.5 cm is observed on the left adnexa. She is hemodynamically stable. What is the most appropriate management for this patient?

Single-dose methotrexate injection. ***Single-dose methotrexate injection*** - The patient presents with a **hemodynamically stable ectopic pregnancy**, as suggested by the positive pregnancy test, amenorrhea, vaginal bleeding, abdominal pain, an hCG level of 2800 IU/L, and an adnexal mass. - A single-dose methotrexate injection is the **first-line medical management** for ectopic pregnancies in stable patients, particularly when hCG levels are typically below 5000 IU/L and the mass size is less than 4 cm (or 3.5 cm in some guidelines). *Oral methotrexate* - **Oral methotrexate** is not typically used for the treatment of ectopic pregnancy due to unpredictable absorption and less reliable therapeutic efficacy compared to intramuscular administration. - The **intramuscular route** is preferred to ensure consistent systemic exposure and effectiveness in dissolving the ectopic gestation. *Serial methotrexate + leucovorin rescue* - **Leucovorin rescue** is used to mitigate the adverse effects of high-dose methotrexate, typically in cancer chemotherapy, and is not indicated for the standard treatment of ectopic pregnancy. - Serial doses of methotrexate without leucovorin may be given if the initial single dose fails, but **leucovorin is not part of the standard initial treatment protocol** for ectopic pregnancy. *Salpingectomy* - **Salpingectomy (surgical removal of the fallopian tube)** is indicated for ectopic pregnancies that are **hemodynamically unstable**, ruptured, too large for medical management (e.g., >4 cm), or in cases where medical management with methotrexate fails or is contraindicated. - Since this patient is **hemodynamically stable** and meets the criteria for medical management, surgery is not the most appropriate initial management. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A primigravida presents to you with anemia early in her pregnancy. She is 7 weeks pregnant as seen on ultrasound. Her hemoglobin level is 9 g/dL. When should the iron supplements be started for her?

Immediately upon diagnosis. ***Correct Option: Immediately upon diagnosis*** - **Iron deficiency anemia** in pregnancy (Hb <11 g/dL in first trimester) should be addressed promptly to prevent adverse maternal and fetal outcomes - Initiating treatment at 7 weeks ensures sustained **iron stores** throughout pregnancy - WHO and ACOG guidelines recommend **immediate supplementation** when anemia is diagnosed during antenatal screening - Early treatment prevents worsening due to physiological plasma volume expansion in second trimester *Incorrect Option: 8 to 10 weeks* - Delaying treatment for 1-3 weeks after diagnosis at 7 weeks is not justified medically - Any delay in treatment allows anemia to worsen and depletes maternal iron stores - Recommended practice is **immediate supplementation** if hemoglobin count is less than 11 g/dL during first two antenatal visits *Incorrect Option: After 14 weeks* - Waiting until second trimester (after 14 weeks) would allow the **anemia to worsen**, making it harder to correct before physiological drop in hemoglobin due to plasma volume expansion - Fetal development, particularly **neurological development**, is rapid in first trimester and iron is crucial during this period - Delaying 7 weeks after diagnosis risks maternal complications and suboptimal fetal development *Incorrect Option: After 20 weeks* - Starting supplementation this late (13 weeks after diagnosis) would result in severe maternal iron deficiency - Significant **fetal iron demands** increase by third trimester, making it difficult to replete maternal stores if supplementation starts this late - **Severe anemia** poses risks such as **preterm birth**, low birth weight, and **postpartum hemorrhage** [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A woman presents to you at 36 weeks of gestation with complaints of breathlessness and excessive abdominal distension. Fetal movements are normal. On examination, fetal parts are not easily felt and fetal heartbeat is heard but it is muffled. Her symphysis fundal height is 41 cm. Her abdomen is tense but not tender. What is the most likely diagnosis?

Polyhydramnios. ***Polyhydramnios*** - The patient's symptoms of **breathlessness**, **excessive abdominal distension**, a **symphysis fundal height of 41 cm at 36 weeks** (indicating a significantly larger than expected uterus), and **muffled fetal heart tones** are classic signs of polyhydramnios. - **Difficulty feeling fetal parts** is also consistent with excess amniotic fluid, which cushions the fetus and makes palpation harder. *Abruptio placenta* - This condition typically presents with sudden onset of **painful vaginal bleeding**, uterine tenderness, and fetal distress, none of which are described here. - While the abdomen might be tense due to uterine contractions or concealed bleeding, the lack of pain and bleeding makes this diagnosis unlikely. *Hydrocephalus of fetus* - Fetal hydrocephalus would primarily manifest as an **abnormally large fetal head** upon ultrasound, potentially leading to a higher fundal height. - However, it wouldn't directly explain the generalized excessive abdominal distension or the difficulty in feeling fetal parts due to fluid, though it could be a cause of polyhydramnios itself, it is not the most likely primary diagnosis from the given options directly addressing the symptoms. *Oligohydramnios* - This condition is characterized by **too little amniotic fluid**, which would result in a **smaller than expected symphysis fundal height** and an easily palpable fetus. - The patient's symptoms, particularly the excessive distension and high fundal height, directly contradict the features of oligohydramnios. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

A lady undergoes radical hysterectomy for suspected stage Ib cancer cervix. Histopathology reveals cancer extension to the lower part of the uterine body with positive surgical margins. What is the next step of management?

Accepted Answer

Chemoradiation

Answer

Chemotherapy

Answer

Radiotherapy

Answer

Follow-up

Question 2

Hysteroscopy is indicated in all of the following except:

Accepted Answer

Active pelvic infection

Answer

Asherman syndrome

Answer

Infertility

Answer

Misplaced intrauterine devices

Question 3

A female presents with 6 weeks of amenorrhea, experiencing vaginal bleeding and slight abdominal pain. A urine pregnancy test is positive, and her hCG level is 2800 IU/L. A mass measuring 3 x 2.5 cm is observed on the left adnexa. She is hemodynamically stable. What is the most appropriate management for this patient?

Accepted Answer

Single-dose methotrexate injection

Answer

Oral methotrexate

Answer

Serial methotrexate + leucovorin rescue

Answer

Salpingectomy

Question 4

A primigravida presents to you with anemia early in her pregnancy. She is 7 weeks pregnant as seen on ultrasound. Her hemoglobin level is 9 g/dL. When should the iron supplements be started for her?

Accepted Answer

Immediately upon diagnosis

Answer

8 to 10 weeks

Answer

After 14 weeks

Answer

After 20 weeks

Question 5

A woman presents to you at 36 weeks of gestation with complaints of breathlessness and excessive abdominal distension. Fetal movements are normal. On examination, fetal parts are not easily felt and fetal heartbeat is heard but it is muffled. Her symphysis fundal height is 41 cm. Her abdomen is tense but not tender. What is the most likely diagnosis?

Accepted Answer

Polyhydramnios

Answer

Abruptio placenta

Answer

Hydrocephalus of fetus

Answer

Oligohydramnios

Question 6

A 17-year-old girl is seen for primary amenorrhea. There is no development of breasts or hair in the pubic or axillary region. Her height is 155 cm, and her weight is 48 kg. She has bilateral inguinal masses. The uterus, fallopian tube, and Ovary are absent on ultrasound examination. What is the most likely diagnosis?

Accepted Answer

Complete androgen insensitivity syndrome

Answer

Turner syndrome

Answer

Polycystic ovary syndrome

Answer

Hypergonadotropic hypogonadism

Question 7

A 23-year-old woman accompanied by her mother-in-law comes to the infertility clinic. She has been having regular intercourse for 6 months but is not able to conceive. What is the next best step?

Accepted Answer

Reassure and review the couple after 6 months

Answer

Hysterolaparoscopy

Answer

Diagnostic hysteroscopy

Answer

Semen analysis for husband

Question 8

A woman comes with complaints of pain and swelling in the perineal area. She also has complaints of difficulty in walking and sitting. She gives a history of multiple sexual partners. On examination, a tender swelling is seen with redness on the labia. What is the most likely diagnosis?

Accepted Answer

Bartholin abscess

Answer

Chlamydial infection

Answer

Genital Tuberculosis

Answer

Herpes infection

Question 9

A 16-year-old girl presents with cyclical pelvic pain every month. She has not achieved menarche yet. On examination, a suprapubic bulge can be seen in the lower abdomen. PR examination reveals a bulging swelling in the anterior aspect. What is the most likely diagnosis?

Accepted Answer

Imperforate hymen

Answer

Transverse vaginal septum

Answer

Vaginal atresia

Answer

Cervical agenesis

Question 10

A pregnant woman comes to the clinic. She has previously delivered twins. What is the correct representation of her obstetric score?

Accepted Answer

G2P1 (2 pregnancies, 1 delivery)

Answer

G3P1 (3 pregnancies, 1 delivery)

Answer

G3P2 (3 pregnancies, 2 deliveries)

Answer

G2P2 (2 pregnancies, 2 deliveries)

NEET-PG 2023 — Obstetrics and Gynecology