NEET-PG 2021 Practice Questions

Q: A patient presents with cannonball lesions in the lungs following a recent molar pregnancy evacuation. What is the most appropriate management?

EMACO regimen. ***EMACO regimen*** - The presence of **cannonball lesions** in the lungs after a molar pregnancy evacuation suggests **gestational trophoblastic neoplasia (GTN)**, specifically **choriocarcinoma** with pulmonary metastases. - The **EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine)** regimen is a highly effective multi-agent chemotherapy protocol for **high-risk GTN**, including metastatic disease. *Inj. Methotrexate* - Single-agent methotrexate is primarily used for **low-risk GTN** or as a single or double-dose regimen in specific cases of persistent GTN. - It is generally insufficient for **high-risk GTN** with pulmonary metastases, where more aggressive multi-agent chemotherapy is required. *Hysterectomy* - While hysterectomy can be an option in specific cases of **non-metastatic GTN**, especially for older patients desiring definitive treatment, it is not the primary treatment for **metastatic disease**. - Systemic chemotherapy is essential to address the widespread nature of metastatic gestational trophoblastic neoplasia. *Multiple dose of Inj. Methotrexate* - Multiple doses of methotrexate might be considered for intermediate-risk GTN or as part of a multi-agent regimen, but it's often not sufficient as a sole agent for **high-risk metastatic disease** indicated by extensive pulmonary lesions. - The **EMACO regime** combines several powerful chemotherapeutic agents for a more comprehensive attack on advanced and metastatic GTN.

Q: A husband requests paternity testing for his twins. The results show that one twin is biologically his child, but the other twin is not. What is the most likely diagnosis?

Superfecundation. ***Superfecundation*** - **Superfecundation** occurs when two separate eggs released in the same menstrual cycle are fertilized by sperm from **different sexual acts or different fathers**, leading to dizygotic twins from separate fathers. - This scenario specifically describes **heteropaternal superfecundation**, where twins are born to one mother but have different biological fathers, making it the most likely diagnosis. *Superfetation* - **Superfetation** refers to the rare phenomenon where a second, new pregnancy is established in a female already pregnant, resulting in fetuses of **different gestational ages**. - This condition is unlikely here as the twins are presumably of similar gestational age, and the issue is paternity, not sequential pregnancies. *Posthumous child* - A **posthumous child** is one born after the death of its father; this term refers solely to the father's marital status at the time of birth or conception, not to the biological paternity of the child as tested. - This option does not explain how one twin could have a different biological father. *None of the options* - This option is incorrect because **superfecundation** accurately describes the phenomenon where twins of the same mother have different biological fathers due to fertilization by sperm from two different partners.

Q: A teenage patient presents with dysmenorrhea and chronic pelvic pain. Upon further investigation, she is found to have a transverse vaginal septum. What is the most likely diagnosis?

Endometriosis. ***Endometriosis*** - This condition is characterized by the presence of **endometrial-like tissue outside the uterus**, which responds to hormonal changes, leading to chronic pelvic pain and dysmenorrhea. - While a transverse vaginal septum isn't a direct cause of endometriosis, this presentation of chronic pain and dysmenorrhea in a teenager strongly suggests endometriosis, and the septum might be an incidental finding or a contributing factor to pain due to outflow obstruction in some cases. *Dermoid cyst* - A dermoid cyst (mature cystic teratoma) is a benign ovarian tumor that typically causes pelvic pain due to its size or torsion, and it does not usually cause dysmenorrhea. - It would not be directly associated with the presence of a transverse vaginal septum. *Tubo-ovarian abscess* - A tubo-ovarian abscess is an inflammatory mass involving the fallopian tube and ovary, typically presenting with acute-onset severe pelvic pain, fever, and leukocytosis. - While it causes pelvic pain, it is usually acute and infectious in nature, and not inherently linked to dysmenorrhea or a transverse vaginal septum. *Hematocolpos/Hematometra* - **Hematocolpos** (blood in the vagina) or **hematometra** (blood in the uterus) results from an outflow obstruction, such as an imperforate hymen or a transverse vaginal septum. - While a transverse vaginal septum could lead to hematocolpos, the primary symptoms would be cyclical abdominal pain progressing from menarche, an abdominal mass, and **amenorrhea** (absence of menstruation), rather than dysmenorrhea (painful menstruation) which implies some menstrual flow.

Q: A 28-year-old married woman is anxious about conception and presents with complaints of profuse vaginal discharge. She has no history of itching. It has been 12 days since her last menstrual period (LMP). What is the most likely cause of her symptoms?

Physiological. ***Physiological*** - **Physiological vaginal discharge** at mid-cycle (12 days post-LMP) is common and normal, often becoming profuse, clear, and elastic, indicating **ovulation**. - The absence of **itching** or other bothersome symptoms supports a non-pathological cause, especially given her anxiety about conception. *Candida* - **Candidal infections** typically present with a **thick, white, curdy discharge** and are characteristically associated with intense **itching**, which is absent in this case. - The discharge is usually not described as profuse or clear. *Trichomonas* - **Trichomoniasis** is associated with a **frothy, greenish-yellow discharge** and often causes **vaginal itching**, **burning**, and a **foul odor**, none of which are described. - While discharge can be profuse, the clinical picture does not align with Trichomonas. *Bacterial vaginosis* - **Bacterial vaginosis** typically presents with a **thin, grayish-white discharge** and a characteristic **"fishy" odor**, especially after intercourse. - **Itching** is less common than with Candida, but the discharge characteristics and the timing relative to ovulation do not fit this diagnosis.

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.

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.

Q: 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?

Crown-Rump Length (CRL) by Ultrasound (USG). ***Crown-Rump Length (CRL) by Ultrasound (USG)*** - For women with **irregular menstrual cycles**, unknown last menstrual period, or those on **hormonal contraceptives**, **early ultrasound measurement of CRL** is the most accurate method for gestational age determination. - CRL is most accurate between **6 and 14 weeks of gestation**, providing a precise estimate within 3-5 days. *Abdominal girth* - **Abdominal girth** is an unreliable and highly variable measure that is not used for accurate gestational age determination. - It is influenced by maternal body habitus, uterine fibroids, and amniotic fluid volume, making it imprecise. *280 days from Last Menstrual Period (LMP)* - This method (Naegele's rule) assumes a **regular 28-day menstrual cycle** and ovulation on day 14, which is not applicable for a woman on **oral contraceptive pills (OCP)** where ovulation is suppressed. - The use of OCPs alters the hormonal profile, generally causing **amenorrhea or withdrawal bleeding** that does not reflect a true ovulatory cycle. *256 days from Last Menstrual Period (LMP)* - This calculation is not a standard or recognized method for determining **estimated date of delivery (EDD)**. - The standard calculation from LMP uses **280 days (40 weeks)** for a full-term pregnancy.

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

Uterine artery, ovarian artery, internal iliac artery. ***Uterine artery, ovarian artery, internal iliac artery*** - Ligation of the **uterine artery** is typically the first step due to its primary role in supplying the uterus. It often resolves PPH. - If PPH persists, the next step is typically bilateral ligation of the **ovarian arteries**, followed by the **internal iliac arteries (hypogastric arteries)**. This sequence progressively reduces blood flow to the uterus while preserving collateral circulation as much as possible. *Uterine artery, internal iliac, obturator artery* - While initial ligation of the **uterine artery** is correct, the **obturator artery** is not a primary target for devascularization in PPH management. - The obturator artery mainly supplies the thigh and pelvic floor, and its ligation would not significantly impact uterine blood flow in the context of PPH. *Uterine artery, pudendal artery, vaginal artery* - **Uterine artery** ligation is appropriate, but the **pudendal artery** is not typically ligated for PPH; it supplies the perineum and external genitalia. - While the **vaginal artery** supplies part of the lower uterus and vagina, it is usually addressed after or in conjunction with the hypogastric arteries if uterine and ovarian vessel ligation is insufficient, and not before ovarian arteries. *Uterine artery, ovarian artery, vaginal artery* - Ligation of the **uterine artery** and **ovarian artery** is correct in sequence, but the **vaginal artery** alone is usually insufficient. - The next major supply to be considered if bleeding persists after uterine and ovarian ligation would be the **internal iliac artery** to address collateral supply from other branches, not just the vaginal artery in isolation.

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

Acyclovir & elective cesarean section (C-section). ***Acyclovir & elective cesarean section (C-section)*** - Active **genital herpetic lesions** at the time of delivery pose a significant risk of transmitting **herpes simplex virus (HSV)** to the neonate. - **Acyclovir** can help suppress viral replication, but a **cesarean section** is necessary to prevent direct contact with the lesions during birth, which could lead to severe neonatal HSV infection. *Wait & watch* - This approach is inappropriate due to the high risk of **vertical transmission** of HSV to the neonate if lesions are active during vaginal delivery, potentially causing life-threatening complications. - **Neonatal HSV** can result in significant morbidity and mortality, including neurological damage and disseminated disease. *Acyclovir & allow spontaneous progression of labor* - While **acyclovir** can reduce viral load, it does not completely eliminate the risk of transmission from active lesions during a vaginal birth. - The primary concern is protecting the neonate from direct contact with the **active lesions** in the birth canal. *Induction of labor* - **Induction of labor** does not mitigate the risk of **vertical transmission** from active lesions during a vaginal delivery. - The focus should be on preventing contact with the lesions, not on expediting vaginal birth once active lesions are present.

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

Occipitoposterior. ***Occipitoposterior*** - **Infraumbilical flattening** of the abdomen is a classic sign of an occipitoposterior position due to the fetal spine lying against the maternal spine. - The **heart sounds are heard laterally** because the fetal back, where the heart sounds are best transmitted, is positioned towards the maternal flanks. *Right occipitoanterior* - In a right occipitoanterior position, the fetal spine is anterior and slightly to the right, leading to a more **convex abdomen** and **heart sounds audible anteriorly** and to the right of the midline. - This position does not typically cause infraumbilical flattening. *Right dorsoanterior* - This term is more commonly associated with a **breech presentation** where the fetal back (dorsum) is anterior. - In a cephalic presentation, "dorsoanterior" is not a standard term for fetal position relative to the occiput. *Left occipitoanterior* - In a left occipitoanterior position, the fetal spine is anterior and slightly to the left, resulting in a **convex abdomen** and **heart sounds audible anteriorly** and to the left of the midline. - Infraumbilical flattening is not a characteristic finding for this position.

Question 1

A patient presents with cannonball lesions in the lungs following a recent molar pregnancy evacuation. What is the most appropriate management?

Accepted Answer

EMACO regimen

Answer

Inj. Methotrexate

Answer

Hysterectomy

Answer

Multiple dose of Inj. Methotrexate

Question 2

A husband requests paternity testing for his twins. The results show that one twin is biologically his child, but the other twin is not. What is the most likely diagnosis?

Accepted Answer

Superfecundation

Answer

Superfetation

Answer

Posthumous child

Answer

None of the options

Question 3

A teenage patient presents with dysmenorrhea and chronic pelvic pain. Upon further investigation, she is found to have a transverse vaginal septum. What is the most likely diagnosis?

Accepted Answer

Endometriosis

Answer

Dermoid cyst

Answer

Tubo-ovarian abscess

Answer

Hematocolpos/Hematometra

Question 4

A 28-year-old married woman is anxious about conception and presents with complaints of profuse vaginal discharge. She has no history of itching. It has been 12 days since her last menstrual period (LMP). What is the most likely cause of her symptoms?

Accepted Answer

Physiological

Answer

Candida

Answer

Trichomonas

Answer

Bacterial vaginosis

Question 5

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 6

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 7

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 8

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 9

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 10

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

NEET-PG 2021

OB/GYN

Obstetrics and Gynecology