NEET-PG 2025 Practice Questions

Q: 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?

14 grams. ***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.

Q: 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?

Endometrial carcinoma. ***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.

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

Mucosa → Muscle → Skin. ***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.

Q: 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?

Immediate pelvic examination and transvaginal ultrasound. ***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 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**.

Q: 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?

Crown-rump length. ***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.

Q: 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?

Probable pregnancy. ***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.

Q: 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?

Bakri balloon tamponade. ***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**.

Q: 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?

High estrogen, high progesterone. ***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**.

Q: A 56-year-old man presents with the following pathology shown in the image, which of the following is correct?

Lipodermatosclerosis/eczema can occur. ***Lipodermatosclerosis/eczema can occurs*** - The image suggests features of **chronic venous insufficiency (CVI)**, including skin discoloration (hyperpigmentation/hemosiderin deposition) and induration, which are classic features leading to **lipodermatosclerosis** and **venous eczema** (C4 changes in CEAP classification). - Lipodermatosclerosis involves inflammation and fibrosis of the skin and subcutaneous fat in the gaiter area due to prolonged **venous hypertension**. *Sclerotherapy is the best treatment* - Sclerotherapy is typically indicated for **small varicose veins** or **telangiectasias**. - For CVI causing advanced skin changes (like lipodermatosclerosis), the best initial treatment is usually **compression therapy** and addressing the source of reflux (e.g., endovenous ablation). *Telangiectasia is rare* - **Telangiectasias** (spider veins) are very common in patients with CVI and often represent the earliest visible sign of **venous disease** (C1 in CEAP classification). - The presence of more advanced skin changes (like those shown) indicates significant venous hypertension, often accompanied by microcirculatory changes including telangiectasia. *No possibility of venous ulcer* - The changes seen (hyperpigmentation and probable underlying induration/atrophy) are stages C4/C5 of the CEAP classification, which are **immediate precursors** to or associated with **venous leg ulcers** (C6). - Venous hypertension is the underlying cause for both the skin changes and the development of **venous ulcers**, making the possibility very real in this patient.

Q: 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?

True phimosis. ***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.

Question 1

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 2

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 3

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 4

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

Question 5

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?

Accepted Answer

Crown-rump length

Answer

Abdominal circumference

Answer

Biparietal diameter

Answer

Mean gestational sac diameter

Question 6

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?

Accepted Answer

Probable pregnancy

Answer

Normal menstrual cycle

Answer

Menopause

Answer

Confirmed pregnancy

Question 7

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?

Accepted Answer

Bakri balloon tamponade

Answer

Compression sutures

Answer

Immediate hysterectomy

Answer

Devascularization surgery

Question 8

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 9

A 56-year-old man presents with the following pathology shown in the image, which of the following is correct?

Accepted Answer

Lipodermatosclerosis/eczema can occur

Answer

Sclerotherapy is the best treatment

Answer

Telangiectasia is rare

Answer

No possibility of venous ulcer

Question 10

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?

Accepted Answer

True phimosis

Answer

Recurrent balanoposthitis

Answer

Balanitis xerotica obliterans

Answer

Recurrent urinary tract infections

NEET-PG 2025

Obstetrics and Gynecology

Physiology

Surgery