Obstetrics and Gynecology
9 questionsA 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?
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?
NEET-PG 2025 - Obstetrics and Gynecology NEET-PG Practice Questions and MCQs
Question 121: 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 122: 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 123: 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 124: 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**.
Question 125: 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 126: 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 127: 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 128: 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 129: 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.
Surgery
1 questionsA 3-year-old child was brought to OPD with complaint of dysuria and ballooning on micturition and examination as given below, what is the diagnosis?
NEET-PG 2025 - Surgery NEET-PG Practice Questions and MCQs
Question 121: A 3-year-old child was brought to OPD with complaint of dysuria and ballooning on micturition and examination as given below, what is the diagnosis?
- A. Recurrent balanoposthitis
- B. Balanitis xerotica obliterans
- C. Recurrent urinary tract infections
- D. True phimosis (Correct Answer)
Explanation: ***True phimosis*** - The image shows a severely narrowed, pinhole-like preputial opening, coupled with **dysuria** and **ballooning on micturition**, which are hallmark symptoms of symptomatic or **pathological phimosis**. - **Ballooning** occurs because the tight foreskin traps urine before it can exit, confirming significant distal urinary outflow obstruction. *Balanitis xerotica obliterans* - Although BXO is a leading cause of pathological phimosis, this diagnosis is reserved for cases showing characteristic **sclerotic, white, atrophic skin changes** around the meatus, which are absent in the image. - BXO typically develops secondary to a chronic inflammatory process and is often considered when the phimosis is **acquired** rather than purely developmental. *Recurrent balanoposthitis* - Balanoposthitis is an inflammation of the glans and prepuce, typically presenting with **erythema, swelling, and discharge**. - While repeated episodes can lead to **scarring and acquired phimosis**, the primary and most concerning diagnosis here is the resulting anatomical obstruction (phimosis) that is causing symptoms. *Recurrent urinary tract infections* - **Recurrent UTIs** are a potential complication of significant true phimosis, resulting from urine stasis and poor hygiene. - However, the symptoms described, especially **ballooning on micturition**, directly indicate the presence of urethral **outflow obstruction**, which is the diagnosis.