NEET-PG 2021 - Obstetrics and Gynecology PYQs Practice Questions

Q: A pregnant woman comes for a routine antenatal checkup. She had a history of a twin pregnancy one year ago. What is her gravida and para status?

G2P1. ***G2P1*** - **Gravida (G)** refers to the total number of confirmed pregnancies, regardless of outcome. This current pregnancy is her second, making her G2. - **Para (P)** denotes the number of pregnancies that have reached viability (typically 20 weeks gestation or more), producing one or more fetuses. Her previous twin pregnancy, regardless of the number of babies, counts as one para event. *G2P3* - While G2 is correct (current pregnancy + previous twin pregnancy), P3 would imply three separate birth events beyond viability, which is not supported by the history of one twin pregnancy. - The number of babies born in a single pregnancy beyond viability does not increase the 'P' count; it refers to the number of pregnancies carried to term. *G2P2* - G2 is correct, but P2 would mean she had two separate pregnancies that reached viability. She only had one previous pregnancy that reached viability (the twin pregnancy). - The para count is determined by the number of deliveries, not the number of fetuses delivered. *G2P0* - While G2 is correct, P0 would mean she has never carried a pregnancy to the point of viability. - Her history clearly states a twin pregnancy one year ago, indicating a previous pregnancy carried to term, making P0 incorrect. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: Which of the following is NOT typically associated with uterine didelphys?

Endometriosis. ***Endometriosis*** - **Endometriosis** is a condition where tissue similar to the lining of the uterus grows outside the uterus; it is not typically associated with specific Müllerian anomalies like uterine didelphys. - While both conditions can cause pelvic pain or infertility, there isn't a direct causal link or increased prevalence of endometriosis specifically due to uterine didelphys. *Premature labor* - **Uterine didelphys** involves two separate uteri, each with its own cervix, which can lead to a smaller uterine cavity in each horn, increasing the risk of **premature labor**. - The abnormal uterine shape and reduced cavity size can compromise the ability to carry a pregnancy to term. *Transverse lie* - The presence of **two separate uterine horns** in uterine didelphys can significantly alter the shape of the uterine cavity, making it difficult for the fetus to assume a regular **longitudinal lie**. - This anatomical variation often predisposes to **malpresentation**, such as **transverse lie**, where the baby lies horizontally across the uterus. *Repeated abortion* - Uterine didelphys is associated with a higher incidence of **repeated abortions** due to various factors including the smaller size of each uterine cavity, potential cervical incompetence, and altered blood supply. - The structural abnormalities can prevent proper implantation or adequate growth of the fetus, leading to recurrent pregnancy losses. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: What is the preferred management of a uterine septum?

Hysteroscopic resection of septum. ***Hysteroscopic resection of septum*** - **Hysteroscopic resection of a uterine septum** is the preferred management due to its minimally invasive nature and high success rates in improving reproductive outcomes. - This procedure allows direct visualization and precise removal of the septal tissue, preserving the healthy uterine musculature. *Laparoscopic resection of septum* - While laparoscopic approaches are minimally invasive, directly resecting a uterine septum laparoscopically is generally **not the primary method**. - Laparoscopy is often used for diagnostics or in conjunction with hysteroscopy for guidance, but not typically for primary septal resection alone. *Uterine metroplasty* - **Uterine metroplasty** is a broader term for surgical reconstruction of the uterus, typically reserved for more complex uterine anomalies like a **bicornuate uterus**. - It involves more extensive surgical remodeling of the uterine cavity and is generally **more invasive** than hysteroscopic septal resection. *Laparotomy and resection* - **Laparotomy** involves a large abdominal incision and is a more invasive surgical approach with a longer recovery period. - It is generally **reserved for very complex uterine malformations** or cases where hysteroscopic or laparoscopic approaches are not feasible or have failed. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A woman with a history of primary infertility is found to have two fibroids in the cornual region and bilateral tubal blockage, with normal ovulation and semen analysis. What is the most appropriate treatment?

Assisted Reproductive Technology (ART). ***Assisted Reproductive Technology (ART)*** - ART, specifically **in vitro fertilization (IVF)**, is the most appropriate treatment as it bypasses both the **tubal blockage** and the **cornual fibroids**, which can interfere with sperm transport and implantation, respectively. - While myomectomy could address the fibroids, it doesn't resolve the tubal blockage, making ART the most direct path to conception given the multifactorial infertility. *Laparoscopic Myomectomy* - This procedure would remove the **fibroids**, which may improve uterine receptivity and reduce potential pregnancy complications. - However, it would not address the **bilateral tubal blockage**, meaning natural conception would still be impossible without further intervention, making it less appropriate as a standalone treatment for primary infertility with multiple causes. *Uterine Artery Embolization* - **Uterine artery embolization (UAE)** is primarily used to manage symptoms of fibroids, such as bleeding and pain, and is generally **not recommended** for women desiring future fertility due to potential risks to ovarian function and uterine blood supply. - It also does not resolve the **tubal factor infertility**. *Hysterectomy* - **Hysterectomy** is the surgical removal of the uterus and is a definitive treatment for problematic fibroids. - However, it permanently **sterilizes** the patient and is therefore completely inappropriate for a woman desiring fertility. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Q: A 24-year-old female patient presents with a few weeks of amenorrhea, a left adnexal mass on ultrasound, and a beta-hCG level of $2500 \mathrm{mIU} / \mathrm{mL}$. No fetal heart rate is detected on the ultrasound. What is the most appropriate management?

Single dose methotrexate. **Single dose methotrexate** - A **beta-hCG level of 2500 mIU/mL** in conjunction with an adnexal mass and no fetal heart rate visible on ultrasound is consistent with an **unruptured ectopic pregnancy** in a hemodynamically stable patient. - **Methotrexate** is a systemic treatment that inhibits trophoblastic cell growth, leading to the resolution of the ectopic pregnancy without surgery. *Expectant management* - This approach is typically reserved for patients with very **low and declining beta-hCG levels** who are completely asymptomatic and have no evidence of rupture. - With a beta-hCG of 2500 mIU/mL and a definite adnexal mass, the risk of rupture is significant, making expectant management inappropriate. *Salpingectomy* - **Salpingectomy** (surgical removal of the fallopian tube) is usually indicated for **ruptured ectopic pregnancies**, hemodynamically unstable patients, or when medical management fails. - While it's an effective treatment, the patient's current presentation (unruptured, stable beta-hCG) allows for a less invasive medical approach first. *Milking of tube* - **"Milking" or "expressing" the tube** is an outdated and potentially harmful maneuver that involves squeezing the fallopian tube to push the ectopic pregnancy out. - This method is associated with **high rates of recurrence** and potential for tubal damage, and is not a recommended treatment for ectopic pregnancy. [Practice more Obstetrics and Gynecology PYQs on OnCourse]

Question 1

A pregnant woman comes for a routine antenatal checkup. She had a history of a twin pregnancy one year ago. What is her gravida and para status?

Accepted Answer

G2P1

Answer

G2P3

Answer

G2P2

Answer

G2P0

Question 2

Which of the following is NOT typically associated with uterine didelphys?

Accepted Answer

Endometriosis

Answer

Premature labor

Answer

Transverse lie

Answer

Repeated abortion

Question 3

What is the preferred management of a uterine septum?

Accepted Answer

Hysteroscopic resection of septum

Answer

Laparoscopic resection of septum

Answer

Uterine metroplasty

Answer

Laparotomy and resection

Question 4

A woman with a history of primary infertility is found to have two fibroids in the cornual region and bilateral tubal blockage, with normal ovulation and semen analysis. What is the most appropriate treatment?

Accepted Answer

Assisted Reproductive Technology (ART)

Answer

Laparoscopic Myomectomy

Answer

Uterine Artery Embolization

Answer

Hysterectomy

Question 5

A 24-year-old female patient presents with a few weeks of amenorrhea, a left adnexal mass on ultrasound, and a beta-hCG level of $2500 \mathrm{mIU} / \mathrm{mL}$. No fetal heart rate is detected on the ultrasound. What is the most appropriate management?

Accepted Answer

Single dose methotrexate

Answer

Expectant management

Answer

Salpingectomy

Answer

Milking of tube

Question 6

A woman has been using oral contraceptive pills (OCP) for 5 months and has had amenorrhea for the last 6 weeks. What is the best method to calculate the gestational age in this case?

Accepted Answer

Crown-Rump Length (CRL) by Ultrasound (USG)

Answer

Abdominal girth

Answer

280 days from Last Menstrual Period (LMP)

Answer

256 days from Last Menstrual Period (LMP)

Question 7

What is the correct order of ligation for devascularization in the management of Postpartum Hemorrhage (PPH)?

Accepted Answer

Uterine artery, ovarian artery, internal iliac artery

Answer

Uterine artery, internal iliac, obturator artery

Answer

Uterine artery, pudendal artery, vaginal artery

Answer

Uterine artery, ovarian artery, vaginal artery

Question 8

A pregnant female presents with active herpetic lesions on the vulva. What is the most appropriate management?

Accepted Answer

Acyclovir & elective cesarean section (C-section)

Answer

Wait & watch

Answer

Acyclovir & allow spontaneous progression of labor

Answer

Induction of labor

Question 9

A patient presents with infraumbilical flattening and the fetal heart rate is heard laterally. What is the most likely fetal position?

Accepted Answer

Occipitoposterior

Answer

Right occipitoanterior

Answer

Right dorsoanterior

Answer

Left occipitoanterior

Question 10

A woman presents with a history of recurrent abortions at 8,11 , and 22 weeks, with normal fetal cardiac activity in all three pregnancies. She also has a history of preeclampsia in her last pregnancy. What is the most probable cause?

Accepted Answer

Antiphospholipid Antibody Syndrome (APLA)

Answer

Syphilis

Answer

Gestational Diabetes Mellitus (GDM)

Answer

TORCH infections

NEET-PG 2021 — Obstetrics and Gynecology