A woman presents for her first antenatal visit and reports that her LMP was approximately 2 months ago. Which ultrasound parameter is the most accurate for dating the pregnancy at this stage?
A woman comes to the clinic with breast tenderness, presence of linea nigra on her abdomen, and a bluish discoloration of the cervix. What is the most likely clinical interpretation of these findings?
A woman develops atonic postpartum hemorrhage (PPH) after vaginal delivery that does not respond to initial medical management. What is the next best step in management in the labour room?
A 42-year-old woman presents with chronic lower abdominal pain and dysmenorrhea. MRI shows diffuse uterine enlargement with junctional zone thickening and scattered high-signal foci in the myometrium. What is the most likely diagnosis?
A woman is diagnosed with a pituitary microadenoma and has elevated serum prolactin levels. She presents with secondary amenorrhea and infertility. What is the most likely mechanism by which hyperprolactinemia causes these symptoms?
A woman diagnosed with cervical cancer is found to have unilateral hydroureteronephrosis on imaging due to tumor invasion. What is the FIGO stage of her disease?
A pregnant woman is undergoing a vaginal breech delivery. After delivering the baby's body up to the umbilicus, the obstetrician notices winging of the baby's scapula. To facilitate safe delivery of the baby's shoulders and head, which of the following maneuvers is most appropriate?
During a clinical examination, a senior resident asks an intern to examine the umbilical cord. How many arteries and veins are normally present in a healthy umbilical cord?
A 28-year-old primigravida woman with a history of preeclampsia undergoes a cesarean section at term. Her BMI is 37. She is currently stable in the postnatal ward. Which of the following is the most appropriate prophylaxis to prevent thrombosis for this patient?
NEET-PG 2025 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 11: A woman presents for her first antenatal visit and reports that her LMP was approximately 2 months ago. Which ultrasound parameter is the most accurate for dating the pregnancy at this stage?
- A. Abdominal circumference
- B. Biparietal diameter
- C. Crown-rump length (Correct Answer)
- D. Mean gestational sac diameter
Explanation: ***Crown-rump length*** - The **Crown-rump length (CRL)** is the most accurate single measurement for establishing gestational age during the first trimester (up to **13 weeks 6 days**). - It is highly reliable because the biological variation in fetal growth rate is minimal before the end of the first trimester, providing an accuracy of about **± 5 to 7 days**. *Biparietal diameter* - **Biparietal diameter (BPD)** is primarily used for dating in the second and third trimesters. - Its accuracy is lower than CRL in the first trimester, and its reliability decreases later in pregnancy due to variation in fetal head shape (**dolichocephaly** or **brachycephaly**). *Mean gestational sac diameter* - The **Mean gestational sac diameter (MSD)** is the preferred parameter only in the earliest stages (around 5 weeks) before the fetal pole/embryo is reliably visualized on ultrasound. - Once the embryo is visible, CRL supersedes MSD as the measurement for dating, as MSD only correlates roughly with gestational age. *Abdominal circumference* - **Abdominal circumference (AC)** is the least accurate measurement for dating the pregnancy. - AC is mainly used in the second and third trimesters to evaluate **fetal growth and weight estimation**, as it is highly prone to variation based on nutritional status.
Question 12: A woman comes to the clinic with breast tenderness, presence of linea nigra on her abdomen, and a bluish discoloration of the cervix. What is the most likely clinical interpretation of these findings?
- A. Normal menstrual cycle
- B. Probable pregnancy (Correct Answer)
- C. Menopause
- D. Confirmed pregnancy
Explanation: ***Probable pregnancy*** - The presence of **linea nigra** (hyperpigmentation) and **breast tenderness** are classic **presumptive signs** of pregnancy due to hormonal elevation. - **Bluish discoloration of the cervix** (known as **Chadwick's sign**) is a vascular phenomenon and a **probable sign** of pregnancy detected upon examination. *Confirmed pregnancy* - This diagnosis requires **positive definitive signs**, such as documentation of **fetal heart tones**, visualization of the fetus via **ultrasound**, or perceiving **fetal movement** by the examiner. - The signs mentioned (Chadwick's sign, linea nigra) are categorized as presumptive or probable, thus not yet meeting the criteria for **confirmed pregnancy**. *Normal menstrual cycle* - While breast tenderness (**mastalgia**) can occur in the luteal phase, the presence of **Chadwick's sign** (bluish cervix) and **linea nigra** is not typical of a regular menstrual cycle. - These specific vascular and hyperpigmentation changes are driven by high levels of **estrogen** and **progesterone** seen in pregnancy. *Menopause* - **Menopause** involves the cessation of menses and is characterized by low estrogen levels, leading to symptoms like **hot flashes** and potentially changes like **vaginal atrophy**. - It does not cause generalized **hyperpigmentation** like **linea nigra** or the marked vascular congestion required for the development of Chadwick's sign.
Question 13: A woman develops atonic postpartum hemorrhage (PPH) after vaginal delivery that does not respond to initial medical management. What is the next best step in management in the labour room?
- A. Compression sutures
- B. Immediate hysterectomy
- C. Bakri balloon tamponade (Correct Answer)
- D. Devascularization surgery
Explanation: ***Bakri balloon tamponade*** - This technique is considered the next step after failure of **initial medical management** (uterotonics) for **atonic PPH**, as it provides a minimally invasive way to achieve **intrauterine tamponade**. - It can be rapidly inserted in the labour room, effectively bridging the time until other definitive surgical measures can be mobilized if needed. *Compression sutures* - These procedures (e.g., **B-Lynch suture**) are **surgical interventions** typically requiring laparotomy and are performed if non-surgical measures like balloon tamponade fail. - They are considered a definitive surgical option, but usually, less invasive methods are attempted first when initial medical management is insufficient. *Devascularization surgery* - This entails procedures like uterine or internal iliac artery ligation, which are reserved for severe or refractory PPH when **uterotonics** and **tamponade balloons** have failed. - These are advanced surgical steps that carry higher risks and are not the immediate next best step after failing initial medical measures. *Immediate hysterectomy* - This is the final, **life-saving measure** when all other conservative and surgical management options (medication, compression, tamponade, devascularization) have failed to control the hemorrhage. - Since it results in loss of fertility and higher morbidity, it is always avoided unless absolutely necessary as a **last resort**.
Question 14: A 42-year-old woman presents with chronic lower abdominal pain and dysmenorrhea. MRI shows diffuse uterine enlargement with junctional zone thickening and scattered high-signal foci in the myometrium. What is the most likely diagnosis?
- A. Adenomyosis (Correct Answer)
- B. Endometrial carcinoma
- C. Endometriosis
- D. Uterine fibroid
Explanation: ***Adenomyosis*** - This diagnosis is strongly suggested by the triad of **chronic lower abdominal pain**, severe **dysmenorrhea**, and an associated **diffusely enlarged uterus** (globular). - MRI typically shows ill-defined thickening of the **junctional zone** (>12 mm) and scattered high-signal intensity foci within the myometrium, representing ectopic endometrial tissue. *Uterine fibroid* - While fibroids cause chronic pain and heavy menstrual bleeding (**menorrhagia**), they less commonly cause severe, primary **dysmenorrhea** compared to adenomyosis. - On imaging, fibroids are typically **well-circumscribed** solid masses with sharply defined borders, unlike the diffuse enlargement of adenomyosis. *Endometriosis* - Endometriosis causes **chronic pelvic pain** and dysmenorrhea, but the symptoms are due to implants outside the uterus (e.g., ovaries, peritoneum). - Imaging (MRI) would primarily show features like **endometriomas** (chocolate cysts) or deep infiltrating nodules, rather than the diffuse myometrial involvement seen here. *Endometrial carcinoma* - The principal symptom of endometrial carcinoma in pre-menopausal women is typically **abnormal uterine bleeding** (menorrhagia or metrorrhagia), not primarily chronic pelvic pain and dysmenorrhea. - MRI would show hallmark features like **focal endometrial thickening** and invasion, which are generally distinct from the diffuse process of adenomyosis.
Question 15: A woman is diagnosed with a pituitary microadenoma and has elevated serum prolactin levels. She presents with secondary amenorrhea and infertility. What is the most likely mechanism by which hyperprolactinemia causes these symptoms?
- A. Increased LH secretion from the pituitary
- B. Antagonism of estrogen receptors
- C. Increased pulsatile FSH secretion
- D. Decreased GnRH secretion from the hypothalamus (Correct Answer)
Explanation: ***Decreased GnRH secretion from the hypothalamus*** - High levels of prolactin directly inhibit the pulsatile release of **Gonadotropin-Releasing Hormone (GnRH)** from the hypothalamus. - This inhibition leads to decreased pituitary secretion of **Luteinizing Hormone (LH)** and Follicle-Stimulating Hormone (FSH), causing **hypogonadotropic hypogonadism**, resulting in anovulation, amenorrhea, and infertility. *Antagonism of estrogen receptors* - Prolactin primarily exerts its reproductive effects centrally on the **hypothalamic-pituitary axis**, not by acting as a peripheral antagonist of estrogen receptors. - The resulting symptoms are due to **low estrogen production** secondary to inhibited gonadotropins, not receptor blockade. *Increased pulsatile FSH secretion* - Hyperprolactinemia actually causes **decreased** and non-pulsatile secretion of FSH and LH, rather than an increase. - If FSH were increased, it would stimulate follicular development and likely lead to ovarian hyperfunction, which is the opposite of the clinical presentation. *Increased LH secretion from the pituitary* - Prolactin actively inhibits LH release, causing **low plasma LH** levels and disrupting the mid-cycle LH surge necessary for ovulation. - The resulting state is one of inadequate follicular stimulation and anovulation, causing infertility and oligomenorrhea/amenorrhea.
Question 16: A woman diagnosed with cervical cancer is found to have unilateral hydroureteronephrosis on imaging due to tumor invasion. What is the FIGO stage of her disease?
- A. Stage IIIB (Correct Answer)
- B. Stage IIIC
- C. Stage IIIA
- D. Stage IIB
Explanation: ***Stage IIIB*** - According to the FIGO 2018 staging, the presence of **hydronephrosis** or a non-functioning kidney due to the primary tumor classifies the disease as **Stage IIIB**. - This signifies locally advanced disease where the tumor has extended to the **pelvic wall** or caused ureteral obstruction. *Stage IIB* - Stage IIB involves tumor extension to the parametrium (the fibrous tissue surrounding the uterus) but specifically **without reaching the pelvic wall** or causing hydronephrosis. - While there is parametrial involvement, it is not sufficient in extent to cause clinical or radiological evidence of **ureteral obstruction**. *Stage IIIA* - This stage is defined by tumor extension to the **lower third of the vagina**, which is a local but not a distant spread criterion. - Importantly, Stage IIIA implies no involvement of the pelvic wall and no **hydronephrosis** or non-functioning kidney based on obstruction. *Stage IIIC* - **Stage IIIC** is defined solely by the presence of lymph node metastases, regardless of the size or extent of the primary tumor. - This includes involvement of either **pelvic lymph nodes (IIIC1)** or **para-aortic lymph nodes (IIIC2)**, which is a different criterion from ureteral obstruction.
Question 17: A pregnant woman is undergoing a vaginal breech delivery. After delivering the baby's body up to the umbilicus, the obstetrician notices winging of the baby's scapula. To facilitate safe delivery of the baby's shoulders and head, which of the following maneuvers is most appropriate?
- A. Burns Marshall maneuver
- B. Lovset maneuver (Correct Answer)
- C. Pinard maneuver
- D. Mauriceau-Smellie-Veit maneuver
Explanation: ***Lovset maneuver*** - The clinical sign of **winging of the scapula** indicates a **nuchal arm** (arm trapped behind the baby's head), which is a specific complication during breech delivery. - The Lovset maneuver is specifically designed to deliver nuchal arms and impacted **shoulders** in breech presentation by causing the posterior shoulder to rotate anteriorly under the symphysis pubis. - The obstetrician achieves this by grasping the baby's pelvis and rotating the trunk **180 degrees** while applying **gentle downward traction**, which releases the trapped arm and allows delivery of the shoulders. *Pinard maneuver* - This maneuver is used to deliver the **legs** when they are extended in breech presentation, by flexing the thigh and performing **outward sweeping** pressure in the popliteal fossa. - It is performed earlier in the delivery to address extended legs, not for addressing nuchal arm or shoulder complications after the body has reached the level of the umbilicus. *Burns Marshall maneuver* - This technique is used for delivery of the **aftercoming head** when the head is already flexed; the baby's body is allowed to **hang down** until the nape of the neck appears under the symphysis pubis. - It is inappropriate at this stage, as the shoulders and nuchal arm must be delivered first before the head is addressed. *Mauriceau-Smellie-Veit maneuver* - This maneuver is specifically designed for the safe delivery and **flexion of the aftercoming head**, using the operator's hand within the vagina to flex the head while applying traction on the baby's shoulders. - The primary concern here is the **delivery of the nuchal arm and shoulders**, which must precede the use of any maneuver for the aftercoming head.
Question 18: During a clinical examination, a senior resident asks an intern to examine the umbilical cord. How many arteries and veins are normally present in a healthy umbilical cord?
- A. 1 artery and 1 vein
- B. 2 arteries and 2 veins
- C. 1 vein and 2 arteries (Correct Answer)
- D. 1 artery and 2 veins
Explanation: ***1 vein and 2 arteries*** - The normal configuration of a healthy umbilical cord is three vessels: **two umbilical arteries** and **one umbilical vein**. - The **umbilical vein** transports oxygenated blood from the placenta to the fetus, whereas the **two umbilical arteries** carry deoxygenated blood and metabolic waste from the fetus back to the placenta. *1 artery and 2 veins* - This configuration is incorrect; normally, the right umbilical vein **atrophies** early in gestation, leaving only a single left umbilical vein. - A cord with two veins suggests a **developmental anomaly** and is not the standard finding. *1 artery and 1 vein* - This pattern is an anomaly known as a **Single Umbilical Artery (SUA)**, which is found in 0.5% to 1% of pregnancies. - SUA is clinically significant as it is associated with an increased risk of **congenital anomalies**, especially renal, cardiac, and chromosomal defects. *2 arteries and 2 veins* - This is an abnormal configuration; while two arteries are standard, the presence of two veins instead of one is due to the failure of the **right umbilical vein** to involute, which is typically a normal event. - The persistence of two veins is highly **atypical** and often requires specialized fetal surveillance.
Question 19: A 28-year-old primigravida woman with a history of preeclampsia undergoes a cesarean section at term. Her BMI is 37. She is currently stable in the postnatal ward. Which of the following is the most appropriate prophylaxis to prevent thrombosis for this patient?
- A. Aspirin
- B. LMWH (Correct Answer)
- C. Clopidogrel
- D. Warfarin
Explanation: ***LMWH*** - **Low Molecular Weight Heparin (LMWH)** is the preferred agent for postpartum VTE prophylaxis in high-risk patients due to its predictable therapeutic response and ease of administration without frequent monitoring. - This patient has multiple VTE risk factors: **Cesarean section**, **BMI > 30 (37)**, and history of **preeclampsia**, mandating pharmacological thromboprophylaxis immediately postpartum (often for 10-14 days). *Warfarin* - **Warfarin**, a Vitamin K antagonist, is generally not the first-line agent for acute postpartum prophylaxis because it requires intensive monitoring via **INR (International Normalized Ratio)** testing. - It has a slower onset of action and is less preferred for short-term prophylaxis compared to the rapid effect of LMWH. *Clopidogrel* - **Clopidogrel** is an **antiplatelet agent** primarily used to prevent arterial thrombosis (e.g., stroke, myocardial infarction) and is ineffective as monotherapy for preventing venous thromboembolism (VTE). - Its mechanism involves irreversible inhibition of the **P2Y12 receptor**, targeting platelet aggregation rather than the coagulation cascade. *Aspirin* - **Aspirin** (low-dose) is an antiplatelet agent primarily used in pregnancy to reduce the risk of preeclampsia recurrence, but it is insufficient for robust VTE prophylaxis post-cesarean section with high-risk factors. - Though it decreases platelet aggregation, its effect on factor-mediated venous coagulation is inadequate for the prevention of **deep vein thrombosis (DVT)** in this setting.