NEET-PG 2025 - Obstetrics and Gynecology PYQs Practice Questions

Q: 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?

Emergency cesarean section. ***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). [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: 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?

Perform an endometrial biopsy. ***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**. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: In managing shoulder dystocia during vaginal delivery, which of the following is the correct sequence of maneuvers?

McRoberts → Rubin → Gaskin → Zavanelli. ***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. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: 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?

Premature ovarian insufficiency (POI). ***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. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

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?

Accepted Answer

Manually elevate the presenting part, fill the bladder retrogradely, and prepare for emergency cesarean section

Answer

Perform vaginal packing to protect the cord

Answer

Administer oxytocin to expedite labor

Answer

Wait and observe

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?

Accepted Answer

Emergency cesarean section

Answer

Administer oxytocin to augment labor

Answer

Perform operative vaginal delivery

Answer

Continue monitoring and wait

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?

Accepted Answer

Perform an endometrial biopsy

Answer

Hysterectomy

Answer

Start combined oral contraceptive pills

Answer

Observe and reassess after a few months

Question 4

In managing shoulder dystocia during vaginal delivery, which of the following is the correct sequence of maneuvers?

Accepted Answer

McRoberts → Rubin → Gaskin → Zavanelli

Answer

Gaskin → McRoberts → Rubin → Zavanelli

Answer

Zavanelli → Gaskin → Rubin → McRoberts

Answer

Rubin → McRoberts → Zavanelli → Gaskin

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?

Accepted Answer

Premature ovarian insufficiency (POI)

Answer

Hypothalamic amenorrhea

Answer

Polycystic ovary syndrome (PCOS)

Answer

Hyperprolactinemia

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?

Accepted Answer

High estrogen, high progesterone

Answer

Low estrogen, high progesterone, high LH and FSH

Answer

Low estrogen, low progesterone, low LH and FSH

Answer

Low estrogen, high progesterone, low LH and FSH

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?

Accepted Answer

14 grams

Answer

5 grams

Answer

4 grams

Answer

10 grams

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?

Accepted Answer

Endometrial carcinoma

Answer

Uterine fibroid

Answer

Endometriosis

Answer

Adenomyosis

Question 9

In the repair of a mediolateral episiotomy, what is the correct order of tissue closure?

Accepted Answer

Mucosa → Muscle → Skin

Answer

Mucosa → Skin → Muscle

Answer

Skin → Muscle → Mucosa

Answer

Muscle → Mucosa → Skin

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?

Accepted Answer

Immediate pelvic examination and transvaginal ultrasound

Answer

Refer her to cardiology before any further evaluation

Answer

Reassure her that this is normal at her age

Answer

Start antihypertensives and observe for 1 week

NEET-PG 2025 — Obstetrics and Gynecology