NEET-PG 2020 - Obstetrics and Gynecology Practice Questions

Q: The depicted instrument (Fallopian ring applicator) is used in which procedure?

Tubectomy (Female Sterilisation). ***Tubectomy (Female Sterilisation)*** - The **Fallopian ring applicator** is a specialized instrument designed for applying **Silastic bands** (Fallopian rings) to the fallopian tubes. - This procedure, known as **laparoscopic tubal ligation** or **female sterilization**, involves occluding the fallopian tubes to prevent the union of sperm and egg. *Punch Biopsy* - A **punch biopsy** uses a circular blade to remove a core of tissue, primarily for **skin or mucosal lesions**. - The instruments involved are a **punch biopsy tool**, forceps, and scissors, which are distinctly different from an applicator. *Bone marrow biopsy set* - A **bone marrow biopsy set** typically includes a specialized needle (e.g., Jamshidi needle) for aspirations and biopsies from the **iliac crest**. - These instruments are designed for obtaining samples from bone and marrow, not for occluding tubular structures. *Trocar and cannula (used for general laparoscopy)* - A **trocar and cannula** system is used to create an access port into a body cavity for **laparoscopic surgery**. - While it facilitates the entry for instruments like the Fallopian ring applicator, it is a general entry tool and not the specific instrument depicted for the tubectomy itself.

Q: A 60 years old Female with intermittent bleeding per vagina, endometrial collection, and thickening with anterior bulging of the fundal area on ultrasound. What is the most probable diagnosis?

Endometrial Polyp. ***Endometrial Polyp*** - Intermittent bleeding and an **endometrial collection** with **thickening** are classic signs of an endometrial polyp. - The **anterior bulging of the fundal area** on ultrasound is characteristic of a **localized, sessile polyp** protruding into the endometrial cavity. - Polyps are benign overgrowths of endometrial tissue that commonly present with postmenopausal bleeding. *Submucous Fibroid* - While submucous fibroids can cause intermittent bleeding and fundal bulging, they typically appear as a distinct **hypoechoic mass arising from the myometrium** with a whorled pattern. - Fibroids are solid lesions, whereas the description of "endometrial collection" suggests a more cystic or polypoid nature. *Adenomyosis* - Adenomyosis involves **endometrial tissue within the myometrium**, typically causing diffuse uterine enlargement with a heterogeneous myometrial echotexture. - It usually presents with **dysmenorrhea and menorrhagia** rather than intermittent bleeding with focal fundal bulging. - The ultrasound findings described are more consistent with an **intracavitary lesion** rather than myometrial pathology. *Endometrial Cancer* - Endometrial cancer is an important consideration in postmenopausal bleeding with endometrial thickening. - However, malignancy typically presents with a **heterogeneous, irregular endometrial pattern** with increased vascularity on Doppler. - The description of a **discrete collection with focal bulging** points more toward a **benign, localized lesion** like a polyp rather than diffuse malignancy.

Q: A 24-year-old woman with a married life of 4 years visits an infertility clinic with a history of recurrent abortion. On further workup, she is found to have a septate uterus. Which surgery has the best reproductive outcome?

Hysteroscopic surgery. ***Hysteroscopic surgery*** - This minimally invasive procedure involves resecting the **septum** using a hysteroscope, which is associated with excellent reproductive outcomes, often achieving **term pregnancy rates of 70-80%**. - It is preferred because it avoids hysterotomy (incision into the uterus), preserving uterine integrity and reducing the risk of future complications during pregnancy and delivery. *Tompkins procedure* - This procedure involves a **laparotomy and longitudinal incision** into the uterus to excise the septum, followed by closure. - While effective, it is a more invasive open surgical approach, leading to a **longer recovery time** and potentially compromising uterine integrity, increasing the risk of future uterine rupture. *Jones procedure* - The Jones procedure is also an **abdominal metroplasty** that involves excising a wedge of tissue from the fundus of the uterus, typically used for **bicornuate uteri**. - It is **highly invasive** and not the preferred method for a septate uterus due to its extensive nature and associated risks. *Strassman procedure* - The Strassman procedure is primarily used for the surgical correction of a **bicornuate uterus** or **uterus didelphys**, involving unification of the two uterine horns. - This procedure is also an **open abdominal surgery** with significant recovery time and risks, and is not applicable for a septate uterus, where the issue is a fibrous or muscular wall within a single uterine cavity.

Q: In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

Middle cerebral artery Doppler wave forms. ***Middle cerebral artery Doppler wave forms*** - This is currently the most widely accepted and **non-invasive** method for monitoring **fetal anemia** in Rh-sensitized pregnancies. - An increase in the **peak systolic velocity (PSV)** in the middle cerebral artery indicates that the fetus is increasing cardiac output to compensate for a reduced oxygen-carrying capacity due to anemia. *Biophysical profile* - The biophysical profile assesses various fetal parameters like **movement**, **tone**, **breathing**, and **amniotic fluid volume**, which are often altered late in the course of severe fetal anemia. - It is a **less sensitive** indicator of early or moderate fetal anemia compared to MCA Doppler. *Amniotic fluid spectrophotometry* - This method measures the **bilirubin levels** in amniotic fluid, which correlates with the severity of hemolysis. - It is an **invasive procedure** (amniocentesis) and has largely been replaced by non-invasive MCA Doppler due to associated risks and better predictive value of Doppler. *Fetal blood sampling* - Fetal blood sampling (cordocentesis) provides a direct measurement of **fetal hemoglobin** and other blood parameters. - While definitive, it is a **highly invasive procedure** with significant risks, reserved primarily for confirmation of severe anemia or for direct transfusion, not for routine monitoring.

Q: Which of the following is NOT used as an emergency contraceptive?

Danazol. ***Danazol*** - **Danazol** is an **androgen derivative** primarily used to treat **endometriosis** and **fibrocystic breast disease**, not for emergency contraception. - Its mechanism involves suppressing **ovarian function** and creating an anovulatory state, which is not suitable for immediate post-coital intervention. *RU 486* - **RU 486 (Mifepristone)** is a **progesterone receptor modulator** that can be used as an emergency contraceptive, especially at higher doses. - It acts by **blocking progesterone receptors**, preventing implantation or inducing abortion if pregnancy has already occurred. *Copper T* - The **Copper T (intrauterine device - IUD)** is a highly effective method of emergency contraception if inserted within 5 days of unprotected intercourse. - It works by causing a **spermicidal effect** and preventing fertilization or implantation by inducing an inflammatory reaction in the uterus. *OCpill* - **OCPills (oral contraceptive pills)**, usually a combination of estrogen and progestin, can be used as emergency contraception when taken in higher doses. - This method, known as the **Yuzpe regimen**, involves taking two doses of combined oral contraceptives within 72 hours of unprotected intercourse to inhibit ovulation or fertilization.

Q: 26 yr lady with delayed cycles presents to the infertility clinic. After diagnosing her to be a case anovulation of 'Normogonadotropic Hypogonadism' type she was put on human menopausal gonadotropin (HMG) for ovulation induction from the second day of her menstrual period. She was 'Triggered' for follicular rupture with Human chorionic gonadotropin (hCG) and on the 19th day of this cycle she developed dyspnoea, reduced urine output, abdominal bloating and pain. What condition is this patient likely suffering from?

Ovarian hyperstimulation syndrome. ***Ovarian hyperstimulation syndrome*** - The patient's history of **ovulation induction** using **HMG** followed by an **hCG trigger** and subsequent symptoms of **dyspnea**, **reduced urine output**, **abdominal bloating**, and pain strongly indicate **ovarian hyperstimulation syndrome (OHSS)**. - **hCG** exacerbates OHSS by increasing vascular permeability, leading to fluid shifts into the third space and resulting in effusions (e.g., ascites, pleural effusion) and hemoconcentration. *Ruptured ectopic pregnancy* - While an **ectopic pregnancy** can cause abdominal pain, it typically presents with a **positive pregnancy test** and **vaginal bleeding**, which are not mentioned. - Dyspnea and reduced urine output are not typical initial symptoms of ruptured ectopic pregnancy; rather, **hypovolemic shock** would be expected. *Theca lutein cysts* - **Theca lutein cysts** are usually **asymptomatic** and benign, often resolving spontaneously. - Although associated with high **hCG levels**, they typically do not cause the acute, severe systemic symptoms like dyspnea and reduced urine output seen in this patient. *Ruptured corpus luteum cyst* - A **ruptured corpus luteum cyst** can cause sudden abdominal pain due to **hemoperitoneum**, but it usually does not lead to severe systemic symptoms like significant dyspnea or reduced urine output unless there is massive hemorrhage. - The clinical picture with **dyspnea** and **reduced urine output** points more towards systemic fluid shifts rather than localized bleeding alone.

Question 1

The depicted instrument (Fallopian ring applicator) is used in which procedure?

Accepted Answer

Tubectomy (Female Sterilisation)

Answer

Punch Biopsy

Answer

Bone marrow biopsy set

Answer

Trocar and cannula (used for general laparoscopy)

Question 2

A 60 years old Female with intermittent bleeding per vagina, endometrial collection, and thickening with anterior bulging of the fundal area on ultrasound. What is the most probable diagnosis?

Accepted Answer

Endometrial Polyp

Answer

Submucous Fibroid

Answer

Adenomyosis

Answer

Endometrial Cancer

Question 3

Which of the following cannot be used as Post-coital contraceptive?

Accepted Answer

A drug primarily used for endometriosis and fibrocystic breast disease (e.g., Danazol)

Answer

A device that prevents fertilization and implantation (e.g., CuT 200)

Answer

A hormonal method that disrupts ovulation (e.g., high-dose estrogens)

Answer

A progesterone receptor blocker used within 72 hours (e.g., RU 486)

Question 4

A 24-year-old woman with a married life of 4 years visits an infertility clinic with a history of recurrent abortion. On further workup, she is found to have a septate uterus. Which surgery has the best reproductive outcome?

Accepted Answer

Hysteroscopic surgery

Answer

Tompkins procedure

Answer

Jones procedure

Answer

Strassman procedure

Question 5

In current obstetrics practice, what is the best test for monitoring sensitized Rh negative mother?

Accepted Answer

Middle cerebral artery Doppler wave forms

Answer

Biophysical profile

Answer

Amniotic fluid spectrophotometry

Answer

Fetal blood sampling

Question 6

Which of the following is NOT used as an emergency contraceptive?

Accepted Answer

Danazol

Answer

RU 486

Answer

Copper T

Answer

OCpill

Question 7

26 yr lady with delayed cycles presents to the infertility clinic. After diagnosing her to be a case anovulation of 'Normogonadotropic Hypogonadism' type she was put on human menopausal gonadotropin (HMG) for ovulation induction from the second day of her menstrual period. She was 'Triggered' for follicular rupture with Human chorionic gonadotropin (hCG) and on the 19th day of this cycle she developed dyspnoea, reduced urine output, abdominal bloating and pain. What condition is this patient likely suffering from?

Accepted Answer

Ovarian hyperstimulation syndrome

Answer

Ruptured ectopic pregnancy

Answer

Ruptured corpus luteum cyst

Answer

Theca lutein cysts

Question 8

24 yr old mother with 7 week POG presents to ANC OPD with accidental low-dose radiation exposure. What is the most appropriate immediate management?

Accepted Answer

Reassure and continue pregnancy

Answer

Perform detailed fetal anomaly scan

Answer

Advise medical termination of pregnancy

Answer

Advise genetic counseling and testing

NEET-PG 2020 — Obstetrics and Gynecology