NEET-PG 2025 — Obstetrics and Gynecology
19 Previous Year Questions with Answers & Explanations
A 38-week pregnant woman in active labor with 5 cm cervical dilatation and regular contractions suddenly develops umbilical cord prolapse. What is the most appropriate immediate management?
A 32-year-old G2P1 woman with a previous cesarean section is undergoing a trial of vaginal delivery at 39 weeks. She is in active labor with 8 cm cervical dilation and fetal station at -1. Continuous fetal monitoring reveals fetal bradycardia, and maternal pulse is 110/min. What is the most appropriate next step in management?
A 46-year-old woman presents with complaints of irregular menstrual cycles and heavy vaginal bleeding for several months. Transvaginal ultrasound reveals an endometrial thickness of 16 mm. What is the most appropriate next step in management?
In managing shoulder dystocia during vaginal delivery, which of the following is the correct sequence of maneuvers?
A 36-year-old woman presents with secondary amenorrhea for the past 8 months. Laboratory investigations reveal FSH of 36 IU/L and AMH of 0.05 ng/mL. What is the most likely diagnosis?
In a woman with a regular 28-day menstrual cycle, which of the following best describes the typical hormonal profile during days 21 to 25 of the cycle?
A 36-week pregnant woman is diagnosed with preeclampsia and started on magnesium sulfate therapy. According to the Pritchard regimen, what is the total loading dose of magnesium sulfate administered initially?
A 65-year-old postmenopausal woman presents with painless vaginal bleeding. She has no history of hormone replacement therapy. What is the most likely diagnosis?
In the repair of a mediolateral episiotomy, what is the correct order of tissue closure?
A 62-year-old postmenopausal woman with a history of hypertension presents with vaginal bleeding. Her blood pressure is 170 / 100 mmHg. What is the most appropriate next step in management?
NEET-PG 2025 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 1: A 38-week pregnant woman in active labor with 5 cm cervical dilatation and regular contractions suddenly develops umbilical cord prolapse. What is the most appropriate immediate management?
- A. Perform vaginal packing to protect the cord
- B. Administer oxytocin to expedite labor
- C. Manually elevate the presenting part, fill the bladder retrogradely, and prepare for emergency cesarean section (Correct Answer)
- D. Wait and observe
Explanation: ***Manually elevate the presenting part, fill the bladder retrogradely, and prepare for emergency cesarean section*** - The immediate priority in **umbilical cord prolapse** is to relieve pressure on the cord by manually elevating the **presenting fetal part** (e.g., the head) to prevent **fetal hypoxia**. - **Retrograde bladder filling** (500–750 mL saline) is a temporary measure, alongside administering **tocolytics** (like terbutaline) to stop contractions, while preparing urgently for an **emergency cesarean section**, which is the definitive management. *Wait and observe* - This approach is highly inappropriate and dangerous, as cord prolapse is an **obstetric emergency** requiring immediate intervention. - Observing or delaying action allows persistent compression, leading rapidly to **fetal circulatory compromise** and death. *Perform vaginal packing to protect the cord* - **Vaginal packing** is ineffective and may actually exacerbate compression on the exposed cord, worsening **fetal blood flow**. - The focus must be on elevating the presenting part away from the cervix and cord. *Administer oxytocin to expedite labor* - **Oxytocin** stimulates uterine contractions, which would significantly increase the compression forces on the **prolapsed cord**, thereby worsening **fetal distress** and ischemia. - Since the cervix is not fully dilated (5 cm), **emergency cesarean section** is necessary, not expedited vaginal delivery.
Question 2: A 32-year-old G2P1 woman with a previous cesarean section is undergoing a trial of vaginal delivery at 39 weeks. She is in active labor with 8 cm cervical dilation and fetal station at -1. Continuous fetal monitoring reveals fetal bradycardia, and maternal pulse is 110/min. What is the most appropriate next step in management?
- A. Administer oxytocin to augment labor
- B. Perform operative vaginal delivery
- C. Continue monitoring and wait
- D. Emergency cesarean section (Correct Answer)
Explanation: ***Emergency cesarean section*** - The combination of **fetal bradycardia** (acute distress) and maternal **tachycardia** (suggesting hemorrhage/shock) in a patient undergoing **trial of labor after C-section (TOLAC)** is highly indicative of **uterine rupture**. - Uterine rupture is a **Category I obstetric emergency** requiring immediate delivery to minimize fetal hypoxia/demise and manage maternal bleeding. *Continue monitoring and wait* - Waiting is dangerous and contraindicated in the presence of non-reassuring fetal tracing (bradycardia) combined with signs pathognomonic for **uterine rupture** (maternal tachycardia). - Any delay in delivery and surgical intervention significantly increases the risk of associated maternal and fetal **morbidity and mortality**. *Administer oxytocin to augment labor* - Oxytocin is absolutely contraindicated when **uterine rupture** is suspected, as increasing uterine contractility will exacerbate the tear, potentially worsening fetal compromise and maternal hemorrhage. - Augmentation would be appropriate only if labor was prolonged and vital signs were reassuring, which is not the case here. *Perform operative vaginal delivery* - The fetal station is still high at **-1**, making an immediate or easy operative vaginal delivery unlikely or risky. - The primary goal is immediate access to the uterus to control bleeding and deliver the fetus, which is best achieved via an **emergency laparotomy** (C-section).
Question 3: A 46-year-old woman presents with complaints of irregular menstrual cycles and heavy vaginal bleeding for several months. Transvaginal ultrasound reveals an endometrial thickness of 16 mm. What is the most appropriate next step in management?
- A. Perform an endometrial biopsy (Correct Answer)
- B. Hysterectomy
- C. Start combined oral contraceptive pills
- D. Observe and reassess after a few months
Explanation: ***Perform an endometrial biopsy*** - A thickened **endometrium (16 mm)** in a perimenopausal woman (46 years old) with **Abnormal Uterine Bleeding (AUB)** significantly increases the risk of endometrial pathology, including **endometrial hyperplasia** or **carcinoma**. - **Endometrial biopsy** is the most appropriate next step, as it provides a definitive tissue diagnosis required to guide subsequent, targeted treatment. *Hysterectomy* - Hysterectomy is a definitive treatment and is typically reserved only after a histological diagnosis of a high-grade abnormality, such as **endometrial cancer**, has been confirmed. - It is premature to proceed with such an invasive surgery before obtaining a tissue diagnosis. *Start combined oral contraceptive pills* - Hormonal therapy like COCPs is used to manage functional causes of AUB (e.g., anovulation), but it should be initiated only after **malignancy is ruled out** by biopsy, as it can mask symptoms of cancer. - A 16 mm endometrial thickness mandates tissue sampling due to the high index of suspicion for premalignant or malignant change. *Observe and reassess after a few months* - Delayed evaluation in this setting significantly increases the risk of diagnosing **endometrial carcinoma** at an advanced stage. - Any woman over 45 years presenting with AUB must undergo investigation, and observation is not acceptable given the pathological **endometrial thickness**.
Question 4: In managing shoulder dystocia during vaginal delivery, which of the following is the correct sequence of maneuvers?
- A. Gaskin → McRoberts → Rubin → Zavanelli
- B. Zavanelli → Gaskin → Rubin → McRoberts
- C. McRoberts → Rubin → Gaskin → Zavanelli (Correct Answer)
- D. Rubin → McRoberts → Zavanelli → Gaskin
Explanation: ***McRoberts → Rubin → Gaskin → Zavanelli*** - This sequence represents the general escalation of maneuvers, starting with the **McRoberts maneuver** and suprapubic pressure, which are the first-line and most effective steps. - Management proceeds logically from simple positional changes/minimal invasiveness (**Rubin's internal rotation, Gaskin position**) to the highly invasive, **last-resort Zavanelli maneuver** (cephalic replacement). *Zavanelli → Gaskin → Rubin → McRoberts* - This sequence is incorrect because the **Zavanelli maneuver** (cephalic replacement) is the absolute last step, only considered after all other maneuvers have failed due to its high associated morbidity. - The crucial and simple first-line maneuver, the **McRoberts maneuver**, is incorrectly placed as the final step in this order. *Rubin → McRoberts → Zavanelli → Gaskin* - The **McRoberts maneuver** is typically performed first along with suprapubic pressure, as it often provides adequate space and disimpaction before internal rotation techniques like Rubin. - The **Zavanelli maneuver** must always be attempted after non-invasive positional changes like the **Gaskin maneuver** (on all fours) have been tried and failed. *Gaskin → McRoberts → Rubin → Zavanelli* - The **McRoberts maneuver** is universally the first physical maneuver attempted after calling for help and assessing the need for episiotomy, so it generally precedes the **Gaskin maneuver**. - While effective, the Gaskin maneuver (assuming the all-fours position) requires repositioning the mother and is usually attempted after the simpler positional change of McRoberts fails.
Question 5: A 36-year-old woman presents with secondary amenorrhea for the past 8 months. Laboratory investigations reveal FSH of 36 IU/L and AMH of 0.05 ng/mL. What is the most likely diagnosis?
- A. Hypothalamic amenorrhea
- B. Polycystic ovary syndrome (PCOS)
- C. Hyperprolactinemia
- D. Premature ovarian insufficiency (POI) (Correct Answer)
Explanation: ***Premature ovarian insufficiency (POI)*** - This diagnosis is defined by secondary amenorrhea before the age of 40 associated with **hypergonadotropic hypogonadism**. - The combination of severely elevated **FSH (36 IU/L)** and extremely low **AMH (0.05 ng/mL)** strongly indicates primary ovarian failure and depletion of the ovarian reserve. *Polycystic ovary syndrome (PCOS)* - PCOS is associated with normal or slightly low FSH levels and an elevated **LH:FSH ratio**. - Affected women usually have **normal or high AMH** levels due to an increased pool of small antral follicles, opposite of the findings here. *Hyperprolactinemia* - Amenorrhea is mediated by the inhibitory effect of prolactin on GnRH, leading to **hypogonadotropic hypogonadism** (low or normal FSH and LH). - The primary biochemical finding would be high **serum prolactin**, which doesn't match the high FSH observed. *Hypothalamic amenorrhea* - This is a form of **hypogonadotropic hypogonadism**, characterized by low **FSH** and **LH** levels due to impaired GnRH release. - It is inconsistent with the patient's markedly elevated FSH level, which signifies a problem originating in the ovary, not the hypothalamus.
Question 6: In a woman with a regular 28-day menstrual cycle, which of the following best describes the typical hormonal profile during days 21 to 25 of the cycle?
- A. Low estrogen, high progesterone, high LH and FSH
- B. High estrogen, high progesterone (Correct Answer)
- C. Low estrogen, low progesterone, low LH and FSH
- D. Low estrogen, high progesterone, low LH and FSH
Explanation: ***High estrogen, high progesterone*** - Days 21 to 25 fall within the **mid-to-late luteal phase** of a 28-day cycle, which is dominated by the corpus luteum. - The corpus luteum secretes large amounts of **progesterone** (peak luteal levels) and **moderate-to-high levels of estrogen** (secondary luteal peak). - Both hormones exert **negative feedback** on the hypothalamus and pituitary, leading to suppressed **LH and FSH** levels. - This combination of high progesterone with moderately elevated estrogen is characteristic of a functional corpus luteum during the mid-luteal phase. *Low estrogen, high progesterone, low LH and FSH* - While **LH and FSH** are correctly low due to negative feedback, and **progesterone** is high, describing estrogen as "low" is inaccurate for days 21–25. - During the mid-luteal phase, the corpus luteum produces a **secondary estrogen peak** that is moderate-to-high, not low. - Low estrogen would only occur if the corpus luteum had already regressed, which happens closer to menstruation (days 26–28). *Low estrogen, high progesterone, high LH and FSH* - High levels of **LH and FSH** occur only during the **LH surge** around day 14 (ovulation) or during the **menstrual/early follicular phase** when steroid hormones are low. - The combination of **high progesterone** and **high gonadotropins** does not occur normally in the menstrual cycle, as progesterone and estrogen suppress LH and FSH through negative feedback. *Low estrogen, low progesterone, low LH and FSH* - This hormonal profile is characteristic of the **late follicular phase** before the LH surge, or the very end of the luteal phase when the corpus luteum regresses. - During days 21–25, the **corpus luteum** is still fully functional, maintaining high levels of **progesterone** and moderate-to-high levels of **estrogen**.
Question 7: A 36-week pregnant woman is diagnosed with preeclampsia and started on magnesium sulfate therapy. According to the Pritchard regimen, what is the total loading dose of magnesium sulfate administered initially?
- A. 14 grams (Correct Answer)
- B. 5 grams
- C. 4 grams
- D. 10 grams
Explanation: ***14 grams*** - The **Pritchard regimen** mandates a total initial loading dose of **14 grams** of magnesium sulfate to rapidly achieve therapeutic serum levels and prevent seizures in severe preeclampsia or eclampsia. - This total dose comprises **4 grams** administered intravenously (IV) over 5-10 minutes, followed immediately by **10 grams** intramuscularly (IM) (5 grams into each buttock). *4 grams* - **4 grams** represents only the initial **intravenous component** of the loading dose, which is necessary for rapid onset of action. - This amount alone is insufficient to sustain the required therapeutic plasma concentration for an adequate duration, necessitating the added IM component. *10 grams* - **10 grams** represents the large intramuscular (IM) component of the loading dose (5g in each buttock), which provides a slow-release depot. - While crucial for the maintenance of therapeutic levels, it does not account for the immediate-acting IV component, hence failing to represent the total loading dose. *5 grams* - **5 grams** is the dose administered into a **single buttock** during the IM loading component (10g total IM) or the dose used for subsequent **maintenance therapy** (5g IM every 4 hours). - This dose, by itself, is far below the required total loading dose necessary to control acute symptoms of preeclampsia/eclampsia.
Question 8: A 65-year-old postmenopausal woman presents with painless vaginal bleeding. She has no history of hormone replacement therapy. What is the most likely diagnosis?
- A. Uterine fibroid
- B. Endometriosis
- C. Endometrial carcinoma (Correct Answer)
- D. Adenomyosis
Explanation: ***Endometrial carcinoma*** - **Painless postmenopausal bleeding** is the cardinal sign of endometrial carcinoma, and **malignancy must be excluded in every postmenopausal woman** presenting with this symptom. - Since the patient is 65 (well past menopause) and not on **Hormone Replacement Therapy (HRT)**, the risk is significantly higher for primary endometrial cancer. - **Key principle**: Any postmenopausal bleeding (even spotting) requires **endometrial sampling** (via endometrial biopsy or D&C) to rule out malignancy. *Adenomyosis* - This condition typically presents in **premenopausal women** (usually 40s and 50s) with symptoms like **dysmenorrhea** (painful periods) and **menorrhagia** (heavy bleeding). - It is highly unlikely to be the cause of isolated new-onset painless bleeding in a woman 15+ years post-menopause. *Uterine fibroid* - Fibroids (leiomyomas) are most common in **reproductive years** and generally cause symptoms like **heavy menstrual bleeding** or pelvic pressure. - While fibroids can sometimes cause postmenopausal bleeding due to atrophy or malignancy (sarcoma), they are less likely than carcinoma to be the primary cause of painless bleeding in this age group. *Endometriosis* - Endometriosis is a disease of **reproductive-aged women** typically causing symptoms like **chronic pelvic pain**, dysmenorrhea, and dyspareunia. - It almost always regresses spontaneously after menopause and does not cause isolated postmenopausal bleeding.
Question 9: In the repair of a mediolateral episiotomy, what is the correct order of tissue closure?
- A. Mucosa → Muscle → Skin (Correct Answer)
- B. Mucosa → Skin → Muscle
- C. Skin → Muscle → Mucosa
- D. Muscle → Mucosa → Skin
Explanation: ***Mucosa → Muscle → Skin*** - Closure of an episiotomy (or a second-degree tear) must start from the deepest layer, which is the **vaginal mucosa**, ensuring the integrity of the vaginal canal. - This is followed by approximation of the **perineal muscles** (perineal body and underlying musculature) to restore structural integrity, and finally, the **perineal skin** is closed. *Skin → Muscle → Mucosa* - This order is incorrect as it attempts to close the most superficial layer (**skin**) first before addressing the deep **vaginal mucosa** layer. - Repair must proceed from the inside out (deep to superficial) to ensure proper anatomical restoration and secure **haemostasis** in the deeper layers. *Muscle → Mucosa → Skin* - Starting with the **muscle layer** is incorrect because the deepest layer, the **vaginal mucosa**, must be repaired first to avoid leaving dead space and ensure a watertight seal. - Correct repair minimizes the risk of infection, persistent bleeding, and **hematoma formation** by sequential layer closure. *Mucosa → Skin → Muscle* - While starting with the **mucosa** is correct, immediately closing the **skin** and skipping the muscle layer leads to inadequate repair of the perineal body. - Failure to approximate the **perineal muscles** compromises pelvic floor integrity, increasing the risk of **perineal laxity** and future uterovaginal prolapse.
Question 10: A 62-year-old postmenopausal woman with a history of hypertension presents with vaginal bleeding. Her blood pressure is 170 / 100 mmHg. What is the most appropriate next step in management?
- A. Refer her to cardiology before any further evaluation
- B. Reassure her that this is normal at her age
- C. Start antihypertensives and observe for 1 week
- D. Immediate pelvic examination and transvaginal ultrasound (Correct Answer)
Explanation: ***Immediate pelvic examination and transvaginal ultrasound*** - **Postmenopausal bleeding (PMB)** must be considered **endometrial cancer** until proven otherwise, necessitating immediate, comprehensive evaluation. - The standard initial workup includes a **pelvic examination** and a **transvaginal ultrasound (TVUS)** to measure **endometrial thickness** (normal <4-5 mm in postmenopausal women). - If endometrial thickness is >4-5 mm or if the endometrium cannot be adequately visualized, an **endometrial biopsy** is indicated. - **Pap smear is NOT part of PMB workup** as it screens for cervical cancer, not endometrial pathology. *Reassure her that this is normal at her age* - **PMB is never normal** and requires mandatory investigation; reassuring her would be negligence and could delay the diagnosis of malignancy. - The history of hypertension is an independent risk factor for **endometrial hyperplasia** and **endometrial carcinoma**. *Refer her to cardiology before any further evaluation* - While her blood pressure is high (Stage 2 hypertension), the **vaginal bleeding** is an acute, potentially malignant symptom that takes immediate priority. - Evaluating hypertension can occur concurrently, but it should not **delay** the urgent gynecological workup. *Start antihypertensives and observe for 1 week* - Starting antihypertensives treats her chronic risk factor, but observation for one week means delaying the crucial diagnostic workup for **endometrial cancer**. - This approach risks advancing the stage of a potentially **treatable malignancy**.