NEET-PG 2024 Practice Questions

Q: Identify the uterus shown in the image?

Bicornuate. ***Bicornuate*** - The image displays a uterus with two distinct uterine horns that are partially fused at the fundus, creating a **heart-shaped external indentation**. - This morphology is characteristic of a **bicornuate uterus**, which results from incomplete fusion of the paramesonephric (Müllerian) ducts. *Didelphys* - A **uterus didelphys** would show two completely separate uteri, each with its own cervix and often a separate vagina. - The image clearly shows a single cervix and a single vaginal canal, with only the upper uterine body being divided. *Arcuate* - An **arcuate uterus** has a small, concave indentation at the fundus, but the overall shape is typically that of a normal uterus with a mild deformity. - The image shows a much more significant division of the uterine cavity than seen in an arcuate uterus. *Septate* - A **septate uterus** has a normal external contour but contains an internal septum that divides the uterine cavity into two parts. - The image demonstrates both internal and external division with a heart-shaped fundal indentation, which distinguishes bicornuate from septate uterus. *Unicornuate* - A **unicornuate uterus** results from failure of one Müllerian duct to develop, creating a single elongated uterine horn. - The image shows two uterine horns, not a single horn, ruling out this diagnosis.

Q: In fertility-preserving prolapse surgery, which bony landmark is used for suspension?

Ischial spine. ***Ischial spine*** - The **ischial spine** serves as a crucial anatomical landmark for **suspension in fertility-preserving prolapse surgery**, particularly for procedures like sacrospinous ligament fixation. - Fixation to the ischial spine helps in supporting the vaginal apex or uterus, maintaining the natural vaginal axis and reducing the risk of recurrence. *Sacral promontory* - The **sacral promontory** is used in sacrocolpopexy or sacrohysteropexy, which traditionally involves mesh fixation and may not be ideal for **fertility preservation** due to potential future pregnancy complications or mesh-related issues. - While it provides strong support, its use might reduce vaginal elasticity and increase risk for future deliveries. *Pubic symphysis* - The **pubic symphysis** is primarily involved in procedures for **stress urinary incontinence** (e.g., tension-free vaginal tape) and is not a primary point for suspending the uterus or vaginal apex in prolapse surgery. - Using it for prolapse repair could alter the normal anatomical relationship and lead to dyspareunia or chronic pain. *Ischial tuberosity* - The **ischial tuberosity** is a bony prominence that provides attachment for various ligaments and muscles of the pelvis and perineum but is **too inferior and lateral** to be effectively used for uterine or vaginal vault suspension. - Its location makes it unsuitable for achieving appropriate apical support in prolapse surgery.

Q: A 45-year-old woman presents with a history of cervical erosion and spotting for the past 2 months. What is the next best step?

LBC + HPV. ***LBC + HPV*** - Cervical erosion and spotting are concerning for **cervical intraepithelial neoplasia (CIN)** or **cervical cancer**, making **Liquid-Based Cytology (LBC)** the appropriate screening method. - **Human Papillomavirus (HPV) testing** is crucial as persistent high-risk HPV infection is the primary cause of cervical cancer and helps in risk stratification and management. *Pap smear + HSV* - A **routine Pap smear** (conventional cytology) is less sensitive than LBC for detecting abnormal cervical cells and is generally being phased out by LBC. - **Herpes Simplex Virus (HSV)** causes genital herpes and is not directly associated with cervical cancer, thus testing for it in this context is not the most appropriate immediate next step. *Pap smear + HBV* - As mentioned, a **routine Pap smear** is not the preferred method for cervical cancer screening compared to LBC. - **Hepatitis B Virus (HBV)** causes liver disease and is entirely unrelated to cervical pathology; therefore, testing for it would be irrelevant to the patient's symptoms. *LBC + HSV* - While **LBC** is the correct advanced cytology method, adding **HSV testing** is not indicated as HSV does not cause cervical cancer or intraepithelial lesions that present with cervical erosion and spotting. - Focus should be on identifying potential malignancy or pre-malignant changes with HPV co-testing, not sexually transmitted infections unrelated to cancer risk.

Q: A young woman presents with prolapse, and a mesh is being placed. Where is this mesh typically fixed to?

Sacral promontory. ***Sacral promontory*** - In **sacrocolpopexy**, a common surgical procedure for vaginal prolapse, a mesh is attached from the vaginal apex to the **anterior longitudinal ligament** overlying the **sacral promontory**. - This anatomical landmark provides a strong, stable point of fixation to support the vagina and prevent recurrence of prolapse. *Ischial spine* - The **ischial spine** is a common landmark for identifying the **pudendal nerve** and for performing a **pudendal nerve block**, not for mesh fixation in prolapse repair. - It is also relevant in measuring the **interspinous diameter** of the pelvis during childbirth, but not for surgical mesh attachment in this context. *Ischial tuberosity* - The **ischial tuberosity** is the bony prominence on which one sits and is an attachment point for various muscles of the **thigh** and **pelvic floor**. - It is not used as a primary fixation point for mesh in vaginal prolapse repair due to its position and lack of direct support for the vaginal apex. *Pubic symphysis* - The **pubic symphysis** is a cartilaginous joint connecting the two **pubic bones** in the anterior pelvis. - While part of the pelvic framework, it does not provide the appropriate superior posterior support needed for **vaginal apex suspension** in prolapse surgery.

Q: Which of the following is a tumor marker associated with ovarian solid-cystic masses?

AFP. ***AFP (Alpha-fetoprotein)*** - **AFP** is a reliable tumor marker for differentiating **germ cell tumors**, especially **yolk sac tumors**, which often present as an ovarian solid-cystic mass. - Elevated **AFP** levels help in diagnosis, monitoring treatment response, and detecting recurrence of these specific ovarian malignancies. *CEA (Carcinoembryonic antigen)* - **CEA** is primarily associated with **gastrointestinal cancers**, such as colorectal cancer, and is less specific for ovarian masses. - While it can be elevated in some mucinous ovarian carcinomas, it's not the most specific marker for a general solid-cystic ovarian mass. *HCG (Human chorionic gonadotropin)* - **HCG** is a key marker for **gestational trophoblastic disease** and some **germ cell tumors**, such as choriocarcinoma. - It is not typically elevated in most common solid-cystic ovarian masses, especially those of epithelial origin. *HER2/neu (Human Epidermal growth factor Receptor 2)* - **HER2/neu** is primarily associated with **breast cancer** and some gastric cancers, playing a role in targeted therapy. - It is not a standard tumor marker for the general evaluation or diagnosis of ovarian solid-cystic masses.

Q: A 30-year-old female, G2L2, with a history of cervical elongation presents for surgical consultation. What is the surgery of choice?

Fothergill. **Fothergill** - The Fothergill operation, or **Manchester procedure**, is a surgical technique used for **cervical elongation** and **genital prolapse**, specifically involving suspension of the cardinal ligaments and cervical amputation. - This procedure addresses both the elongated cervix and associated pelvic organ prolapse without removing the uterus, making it suitable for women who wish to retain their uterus. *McCall* - The McCall culdoplasty is primarily performed to correct **vaginal vault prolapse** and is typically done during a hysterectomy or for post-hysterectomy prolapse. - It involves plicating the uterosacral ligaments to provide support to the vaginal vault; it does not directly address cervical elongation. *Lefort* - The Lefort colpocleisis is a **partial vaginal closure** procedure performed for severe pelvic organ prolapse in elderly women who are no longer sexually active. - This operation reduces symptoms of prolapse but closes off a significant portion of the vagina, making it unsuitable for sexually active patients or those desiring uterine preservation for fertility. *Hysterectomy* - A hysterectomy involves the **surgical removal of the uterus**, which would address cervical elongation by default as the cervix is part of the uterus. - However, for a 30-year-old female who may wish to retain reproductive function or avoid an extensive surgery if other options are available, hysterectomy is usually not the first-line choice for isolated cervical elongation.

Q: A pregnant woman presents with an IUD in place, and the thread is clearly visible. She wishes to continue the pregnancy. What is the most appropriate next step?

Remove gently. ***Remove gently*** - When the **IUD thread is visible**, gentle removal is recommended if the woman wishes to **continue the pregnancy**, as this significantly reduces the risk of miscarriage and infection. - Leaving an **IUD in situ** during pregnancy increases risks of **septic miscarriage**, **preterm delivery**, and **chorioamnionitis**. *Leave the IUD inside* - Leaving an **IUD in place** during pregnancy increases the risks of **septic miscarriage**, **chorioamnionitis**, and **preterm labor**. - The presence of the IUD can also lead to **placental complications** and difficulties with fetal development. *MTP (Medical Termination of Pregnancy)* - MTP is an option for unintended pregnancies but is not the most appropriate first step when the patient explicitly **wishes to continue the pregnancy**. - MTP would be considered if the patient chose to terminate, but the question states she wants to continue. *Cesarean section* - **Cesarean section** is a mode of delivery and is not an appropriate initial intervention for an early pregnancy with an **IUD in situ**. - The removal of an IUD from an early pregnancy does not necessitate a cesarean section.

Q: Tubectomy is typically performed on which part of the fallopian tube and why?

Isthmus - narrowest. ***Isthmus - narrowest*** - The **isthmus** is preferred for tubectomy because its **narrowest diameter** and thick muscular wall make it easier to ligate and minimize recanalization. - Its narrow lumen also reduces the chances of spontaneous rejoining and pregnancy, ensuring a more effective and permanent sterilization. *Ampulla - uniform thickness of muscle* - The **ampulla** is a wider, more distensible part of the fallopian tube, making it **less suitable for ligation** due to a higher risk of recanalization. - While tubular muscle thickness is a factor, the **ampulla's larger lumen** makes it less ideal for effective and permanent occlusion compared to the isthmus. *Ampulla - widest* - The **ampulla's wider diameter** increases the technical difficulty of creating a secure and permanent occlusion, as ligating a broad segment is less effective. - A wider lumen makes **spontaneous recanalization** more likely, compromising the contraceptive efficacy of the procedure. *Isthmus - uniform thickness of muscle* - While the isthmus does have a relatively **uniform and thick muscular wall**, it is the **narrowness of the lumen** that is the primary reason for its selection in tubectomy. - The consistency of its muscle is a contributing factor to its robustness, but the **small caliber** is key to preventing recanalization.

Q: Identify the pathological condition shown in the image:

Adenomyoma. ***Adenomyoma*** - The image distinctly shows **endometrial glands and stroma** embedded within the **myometrium** (smooth muscle layer of the uterus), which is the hallmark of adenomyoma [1]. - This condition is essentially a localized form of **adenomyosis**, presenting as a mass [1]. *Intramural fibroid* - An intramural fibroid (leiomyoma) is a **benign tumor of smooth muscle cells**, typically showing a proliferation of uniform spindle cells with characteristic swirling patterns [2]. - It would lack the presence of **endometrial glands and stroma** within the lesion [2]. *Endometriosis* - Endometriosis involves the presence of **endometrial tissue outside the uterus**, such as on the ovaries, peritoneum, or bowel. - While it involves similar tissue, its location is **extrauterine**, whereas the image depicts a lesion within the uterine wall. *Myomatous polyp* - A myomatous polyp (or submucosal fibroid) is a **fibroid that protrudes into the uterine cavity**, often covered by endometrial tissue [2]. - The image does not show a polypoid growth extending into the cavity but rather glandular tissue directly within the muscle wall. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Female Genital Tract Disease, pp. 475-476. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1024-1025.

Question 1

Identify the uterus shown in the image?

Accepted Answer

Bicornuate

Answer

Didelphys

Answer

Arcuate

Answer

Septate

Answer

Unicornuate

Question 2

In fertility-preserving prolapse surgery, which bony landmark is used for suspension?

Accepted Answer

Ischial spine

Answer

Sacral promontory

Answer

Pubic symphysis

Answer

Ischial tuberosity

Question 3

A 45-year-old woman presents with a history of cervical erosion and spotting for the past 2 months. What is the next best step?

Accepted Answer

LBC + HPV

Answer

Pap smear + HSV

Answer

Pap smear + HBV

Answer

LBC + HSV

Question 4

A GSP4 woman comes for routine sonography for the first time. She has four daughters and expresses a desire for a boy this time, asking for sex determination. To abide by ethical guidelines, what should you do?

Accepted Answer

Check routine ANC and sex for developmental abnormalities and do not reveal gender to the patient

Answer

Check routine ANC and sex for developmental abnormalities and do reveal gender to the patient

Answer

Do reveal gender if a girl

Answer

Check only routine ANC, do not check sex

Question 5

A young woman presents with prolapse, and a mesh is being placed. Where is this mesh typically fixed to?

Accepted Answer

Sacral promontory

Answer

Ischial spine

Answer

Ischial tuberosity

Answer

Pubic symphysis

Question 6

Which of the following is a tumor marker associated with ovarian solid-cystic masses?

Accepted Answer

AFP

Answer

CEA

Answer

HCG

Answer

HER2/neu

Question 7

A 30-year-old female, G2L2, with a history of cervical elongation presents for surgical consultation. What is the surgery of choice?

Accepted Answer

Fothergill

Answer

McCall

Answer

Lefort

Answer

Hysterectomy

Question 8

A pregnant woman presents with an IUD in place, and the thread is clearly visible. She wishes to continue the pregnancy. What is the most appropriate next step?

Accepted Answer

Remove gently

Answer

Leave the IUD inside

Answer

MTP (Medical Termination of Pregnancy)

Answer

Cesarean section

Question 9

Tubectomy is typically performed on which part of the fallopian tube and why?

Accepted Answer

Isthmus - narrowest

Answer

Ampulla - uniform thickness of muscle

Answer

Ampulla - widest

Answer

Isthmus - uniform thickness of muscle

Question 10

Identify the pathological condition shown in the image:

Accepted Answer

Adenomyoma

Answer

Intramural fibroid

Answer

Endometriosis

Answer

Myomatous polyp

NEET-PG 2024

Anatomy

OB/GYN

Obstetrics and Gynecology

Pathology