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: What is the typical time between fertilization and implantation?

8 days. ***8 days*** - **Fertilization** typically occurs in the **fallopian tube**, and the resulting **zygote** then undergoes several cell divisions while migrating towards the uterus. - Implantation, the process by which the **blastocyst embeds into the uterine wall**, usually begins around day 6 post-fertilization and is completed by day 8-10. *2 days* - At 2 days post-fertilization, the embryo is typically in the **2-cell to 4-cell stage** and is still located within the fallopian tube, far from the implantation site. - This stage is too early for implantation to occur, as the embryo has not yet reached the **blastocyst stage** or the uterus. *14 days* - By 14 days post-fertilization, implantation would have long been completed, and the initial stages of **trophoblast development** and formation of the **placenta** would be underway. - This time frame represents a more advanced stage of pregnancy, whereas implantation is an early event. *16 days* - Sixteen days post-fertilization is well past the window for initial implantation; at this point, significant embryonic development has occurred, and the woman might even be experiencing early signs of **pregnancy**, such as a missed period. - Implantation is a much earlier process, concluding by day 10 at the latest.

Q: A pregnant woman with a known case of asthma is experiencing postpartum hemorrhage (PPH). Which drug is contraindicated?

Carboprost. ***Carboprost*** - **Carboprost** is a **prostaglandin F2-alpha analog** that causes strong uterine contractions but also leads to **bronchoconstriction** and increased airway resistance. - Due to its potent bronchoconstrictive effects, **carboprost** is **absolutely contraindicated in patients with asthma** as it can precipitate a severe asthmatic attack. *Methyl ergometrine* - **Methyl ergometrine** is an **ergot alkaloid** that causes sustained uterine contractions and is effective for PPH. - It is contraindicated in patients with **hypertension** or **pre-eclampsia** due to its vasoconstrictive properties, but not typically in asthma. *Misoprostol* - **Misoprostol** is a **prostaglandin E1 analog** used for PPH management, causing uterine contractions. - It is generally safe for use in patients with asthma as it does not have significant bronchoconstrictive side effects. *Oxytocin* - **Oxytocin** is a first-line uterotonic agent for PPH, working by causing rhythmic uterine contractions. - It is generally considered safe in patients with asthma and is not known to exacerbate respiratory conditions.

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: Identify the instrument shown in the image below:

Kielland. ***Kielland*** - Kielland forceps are distinguished by their **lack of pelvic curve** and the presence of a sliding lock mechanism designed for **rotation of the fetal head**. - They are primarily used for **rotational delivery** when the fetal head is in malposition, often in the mid-pelvis. *Simpson* - Simpson forceps have a distinct **cephalic curve** for grasping the fetal head and a **pelvic curve** to conform to the birth canal. - They are commonly used for **outlet and low-cavity deliveries** where minimal rotation is needed. *Wrigley* - Wrigley forceps are a type of **outlet forceps** with a very short shanks and blades, making them suitable only when the fetal head is on the **perineum**. - They are designed for situations where the head is already visible without separating the labia. *Pipers* - Pipers forceps are specifically designed for **delivery of the after-coming head in breech presentations**. - They feature a long, curved shank that allows placement from below the maternal pelvis to grasp the fetal head in this particular presentation.

Q: Which of the following is not a contraindication for External Cephalic Version (ECV)?

Primigravida. ***Primigravida*** - Being a **primigravida** (first pregnancy) is not a contraindication for ECV, though it might be associated with a slightly lower success rate compared to multiparous women due to a less pliable uterus. - While it may indicate a potentially more challenging ECV due to higher uterine tone, it does not preclude the procedure if other conditions are favorable. *Placenta previa* - **Placenta previa** is a contraindication because the manipulation of the uterus during ECV could dislodge the placenta, leading to **severe hemorrhage** and potential fetal compromise. - This condition involves the placenta covering the cervical opening, making any uterine intervention risky. *Twin pregnancy* - **Twin pregnancy** is a contraindication as ECV is generally not recommended in multiple gestations due to increased complexity and risk of complications. - The risk of **umbilical cord entanglement**, disruption of twin positioning, and potential harm to either fetus makes ECV unsafe in twin pregnancies. *PROM (Premature Rupture of Membranes)* - **Premature Rupture of Membranes (PROM)** is a contraindication due to the increased risk of uterine infection and **cord prolapse** during manipulation. - Once membranes are ruptured, the natural cushioning provided by the amniotic fluid is lost, making ECV potentially traumatic for both the mother and the fetus.

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: 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

What is the typical time between fertilization and implantation?

Accepted Answer

8 days

Answer

2 days

Answer

14 days

Answer

16 days

Question 3

A pregnant woman with a known case of asthma is experiencing postpartum hemorrhage (PPH). Which drug is contraindicated?

Accepted Answer

Carboprost

Answer

Methyl ergometrine

Answer

Misoprostol

Answer

Oxytocin

Question 4

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 5

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 6

Identify the instrument shown in the image below:

Accepted Answer

Kielland

Answer

Simpson

Answer

Wrigley

Answer

Pipers

Question 7

Which of the following is not a contraindication for External Cephalic Version (ECV)?

Accepted Answer

Primigravida

Answer

Placenta previa

Answer

Twin pregnancy

Answer

PROM (Premature Rupture of Membranes)

Question 8

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 9

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 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