Practice Paper of NEET PG: Important Questions of OBSTETRICS & GYNAECOLOGY

The Important Questions of Obstetrics & Gynaecology for NEET PG exam:

1. The quantity of hormone released by Progestasert per day is?
A. 25 µg
B. 45 µg
C. 65 µg
D. 85 µg

Correct answer : C. 65 µg

Progesterone releasing IUCD – Mirena

  • Progestasert is a commonly used IUCD which carries 38 mg of progesterone in silicone oil reservoir.
  • It releases 65 µg of hormone per day.
  • It acts by forming a thick plug of mucus at the cervical os which prevents penetration by the sperm.\

 

2. Which of the following is true regarding Organ of Rosenmuller?
A. Forms paraovarian cyst
B. Consist of horizontal tubules in mesovarium
C. Tubules are lined by columnar cells
D. Represents cranial end of the Wolffian body

Correct answer : D. Represents cranial end of the Wolffian body

Uterus and broad ligament. Epoophoron visible in the upper right.

  • Organ of Rosenmuller (epoophoron) represents cranial end of the Wolffian body.
  • It consists of vertical tubules in the mesovarium and mesosalpinx.
  • The tubule is lined by cubical cells.
  • Paroophoron sometimes forms paraovarian cyst.

 

3. Tumour secreting placental alkaline phosphatase is?
A. Carcinoid tumour
B. Arrhenoblastoma
C. Granulosa cell tumour
D. Dysgerminoma

Correct answer : D. Dysgerminoma

Seminoma of testis: Histologically indistinguishable from dysgerminoma of ovary

  • Dysgerminoma corresponds to seminoma of the testis.
  • It is usually seen in young women or children.
  • It secretes placental alkaline phosphatase.
  • It does not secrete male of female sex hormones.

 

4. All of the following are germ cell tumours except?
A. Mesonephroid tumors
B. Teratoma
C. Dysgerminoma
D. Endodermal sinus tumour

Correct answer: A. Mesonephroid tumors

Ovarian clear cell carcinoma

  • Germ cell tumours include Teratoma, Dysgerminoma, Endodermal sinus tumour, Embryonal carcinoma, Polyembryoma, Choriocarcinoma and mixed forms.
  • Mesonephroid tumour is an epithelial tumour.
  • It is also known as clear cell carcinoma.
  • It is an uncommon tumour of ovary.
  • It is highly malignant.

 

5. Which of the following is not true regarding Large Loop Excision of the Transformation Zone (LLETZ)?
A. Uses low voltage diathermy
B. Applicable only to cervix
C. Loop size greater than 2cm gives a better cone
D. Shorter procedure time compared to laser ablation

Correct answer : C. Loop size greater than 2cm gives a better cone

Cervical intraepithelial neoplasia

  • Large Loop Excision of the Transformation Zone (LLETZ) uses low voltage diathermy.
  • It is used in the treatment of cervical intraepithelial neoplasias.
  • It is used only for cervical lesions.
  • Loop size lesser than 2cm gives a better cone.
  • It is less costly and has shorter procedure time compared to laser ablation.
  • But the success rate is similar to laser ablation.

 

6. Solid tumour with cystic areas in between filled with haemorrhagic fluid and accounting for about 20% of all ovarian cancers is?
A. Cystadenocarcinoma
B. Mesonephroid tumors
C. Endometrioid tumour
D. Brenner tumour

Correct answer : C. Endometrioid tumour

Ovarian cancer – CT scan

  • Endometrioid tumours account for about 20% of all ovarian cancers.
  • They are mostly malignant.
  • They are lined by glandular epithelium.
  • They are moderate sized solid tumours with cystic areas in between filled with haemorrhagic fluid.
  • Ovarian endometriosis coexist in 15% of cases.

 

7. Moschcowitz repair is done for?
A. Vault prolapse
B. Enterocoele
C. Chronic inversion of uterus
D. Adenomyosis

Correct answer : B. Enterocoele

  • In Moschcowitz repair, several purse string sutures starting from below are used to obliterate the cul-de-sac of the pouch of Douglas.
  • Care should be taken not to include the ureter in the stitch.

 

8. Which is true regarding Savage syndrome?
A. Receptor defect to gonadotrophic hormones
B. Short stature
C. Ovaries do not contain follicles
D. FSH is normal

Correct answer : A. Receptor defect to gonadotrophic hormones

  • In Savage syndrome, there is receptor defect to gonadotrophic hormones.
  • The clinical features resemble autoimmune disease.
  • Height is normal.
  • The ovaries contain follicles.
  • FSH is raised.

 

9. Which of the following is true regarding RU 486?
A. Prevents fertilization
B. Has affinity for estrogen receptors
C. Single dose of 10mg prevents pregnancy in 90% cases
D. Causes delayed menstruation

Correct answer : D. Causes delayed menstruation

  • RU 486 (mifepristone) does not prevent fertilization.
  • It has affinity for progesterone receptors.
  • It blocks the action of progesterone on the endometrium.
  • It prevents implantation by causing sloughing and shedding of decidua.
  • Single dose of 10mg prevents pregnancy in 99.1% cases.

 

10. Absence of corkscrew glands is seen in?
A. Halban’s disease
B. Polycystic ovarian disease
C. Irregular ripening
D. Metropathia haemorrhagica

Correct answer : D. Metropathia haemorrhagica

Endometrial histology – secretory phase

  • The characteristic feature of endometrium in metropathia haemorrhagica is cystic glandular hyperplasia.
  • Another important feature is absence of secretory endometrium with absence of corkscrew glands.
  • Endometrium is usually thick and polypoidal.
  • Thin polypi project into the uterine cavity.

 

11. All are true regarding medical treatment of endometriosis except?
A. Oral progestins cause decidualization of endometrial tissue
B. Injectable progestagen is used once in 3 months in the management of pain of endometriosis
C. Levonorgestrel releasing intrauterine system reduces dysmenorrhoea in endometriosis
D. Gestrinone is given orally 2.5 – 5 mg per day to induce endometrial atrophy

Correct answer : D. Gestrinone is given orally 2.5 – 5 mg per day to induce endometrial atrophy

Laparoscopic view of endometriotic lesions in the peritoneum

  • Gestrinone has a long half life.
  • It is a 19-nortestosterone derivative.
  • It is given orally 2.5 to 5 mg twice weekly for 6 to 9 months.
  • It has androgenic, antiprogestagenic, antioestrogenic and antigonadotrophic action.

 

12. Which of the following is not a contraindication to pregnancy?
A) Severe pulmonary hypertension
B) Severe obstructive valvular lesions
C) Large secundum atrial septal defect with left to right shunt
D) Marfan syndrome with dilated aorta

Correct answer: C) Large secundum atrial septal defect with left to right shunt

  • Pregnancy is associated with many haemodynamic changes.
  • There is increase in heart rate and cardiac output and decrease in peripheral resistance.
  • Total blood volume is increased.
  • Stenotic lesions and severe cyanotic lesions have a higher complication rate during pregnancy.
  • Regurgitant lesions and left to right shunts (without pulmonary hypertension) are better tolerated.

 

13. The use of which of the following drugs for the treatment of menorrhagia is not supported by clinical evidence?
A. Tranexamic acid
B. Oral contraceptives
C. Ethamsylate
D. Progesterone only pills

Correct answer : C. Ethamsylate

Studies have failed to prove the effectiveness of ethamsylate in the treatment of menorrhagia.

DRUGS USED FOR THE TREATMENT OF MENORRHAGIA

Non hormonal agents

  • Nonsteroidal antiinflammatory drugs
    • They are the first line treatment in ovulatory menorrhagia
    • Studies have demonstrated a 20-46% reduction in menstrual blood flow
  • Antifibrinolytics
    • Prevent fibrinolysis and breakdown of clots
    • eg: Tranexamic acid, Epsilon amino caproic acid
  • Ethamsylate

Hormonal agents

  • Progesterone therapy
    • They prevent endometrial proliferation
    • eg: Norethisterone, Medroxyprogesterone acetate, Dydrogesterone

MIRENA Levonorgestrel IUD

  • IUD’s which release progesterone
    • They reduce menstrual blood flow by as much as 97% (after 12 months of use) and are as effective as hysteroscopic endometrial ablation
    • eg: MIRENA, Progestasert
  • Combined estrogen and progesterone pills
    • Used if the woman does not desire to become pregnant
    • They are more effective than using estrogen / progesterone alone
    • They decrease blood loss by 50% and prevent dysmenorrhoea
    • Side effects include breakthrough bleeding, nausea, breast tenderness and weight gain
  •  Danazol
    • It is a synthetic ethisterone derivative that has weak androgenic, anabolic and progestational action
    • It inhibits pituitary secretion of gonadotropins and inhibits steroidogenic enzymes
    • It reduces menstrual blood loss
    • Complete amenorrhoea can occur with higher doses
    • It can cause androgenic side effects like acne, hirsutism and decreased breast size
  • GNRH agonists
    • They are expensive and are used only when other drugs fail to provide relief
    • They inhibit pituitary release of FSH and LH
    • They can cause menopausal symptoms and osteoporosis

 

14. Gold standard test for measuring ß HCG levels in serum is?
A. ELISA
B. Bioassay
C. Radioimmunoassay
D. Latex agglutination test

Correct answer : C. Radioimmunoassay

Radioimmunoassay is the most sensitive test for measurement of ß HCG levels in serum.

ELISA plate

IMMUNOLOGICAL TESTS FOR DIAGNOSIS OF PREGNANCY

Immunological tests for the diagnosis of pregnancy depend on the detection of ß HCG in the maternal serum or urine. They are of various types:

  • Agglutination inhibition test
  • Direct agglutination test
  • Enzyme linked immunosorbent assay (ELISA)
  • Fluoroimmunoassay (FIA)
  • Radioimmunoassay (RIA)
  • Immunoradiometric assay (IRMA)

Other uses of ß HCG testing:

  • Diagnosing ectopic pregnancy
  • Monitoring patients who have underwent in vitro fertilization and embryo transfer
  • Follow up of patients after treatment of hydatidiform mole and choriocarcinoma

 

15. False regarding hormone levels in polycystic ovarian disease?
A. Increased Androgen
B. Increased Prolactin
C. Increased LH
D. Increased LH/FSH ratio

Correct answer : B. Increased Prolactin

 

Polycystic ovary – Ultrasound scan

HORMONE LEVELS IN POLYCYSTIC OVARIAN DISEASE

  • Increased Androgen
  • Increased Estrogen
  • Increased Luteinizing hormone
  • Decreased Follicular stimulating hormone
  • Increased LH/FSH ratio (>2)
  • Increased insulin

 

16. Most specific marker for neural tube defects is?
A. Alpha-fetoprotein
B. Unconjugated estriol
C. Acetylcholinesterase
D. Pseudocholinesterase

Correct answer : C. Acetylcholinesterase

Both alpha-fetoprotein and acetylcholinesterase in amniotic fluid are markers for neural tube defects. But acetylcholinesterase is the most specific marker.

 

17. A 13-year old girl came to the casualty with acute lower abdominal pain. She had cyclical pain for the last 6 months. She has not yet attained her menarche. On examination, a tense bulge was seen in the region of the hymen. The most probable diagnosis is?

A. Mayer-Rokitansky-Küster-Hauser syndrome
B. Imperforate hymen
C. Asherman’s syndrome
D. Congenital adrenal hyperplasia

Correct answer : B. Imperforate hymen

  • Imperforate hymen prevents the drainage of menstrual blood.
  • This results in the accumulation of blood in the vagina leading to hematocolpos.
  • This is visualised as the tense bulge.
  • In long standing cases it can even lead to hematometra.

 

18. A 27-year old primigravida presented to the OPD with pregnancy induced hypertension at 32 weeks of gestation. She had no other complications. On examination she had a blood pressure of 150/100 mm of Hg. Her blood pressure was later controlled with treatment. lf there are no complications, the pregnancy should be terminated at?

A. 40 completed weeks
B. 37 completed weeks
C. 36 completed weeks
D. 34 completed weeks

Correct answer : B. 37 completed weeks

 

19. Weight gain in pregnancy depends on all except?

A. Smoking
B. Pre pregnancy weight
C. Ethnicity
D. Maternal age

Correct answer : A. Smoking

FACTORS INFLUENCING WEIGHT GAIN IN PREGNANCY

  • Maternal age – Increased weight gain in younger women
  • Physical activity – Several studies have demonstrated an inverse relation between weight gain and level of physical activity
  • Prepregnancy weight – Weight gain in pregnancy is generally inversely proportional to BMI (Body Mass Index) in the pre pregnancy period
  • Race / ethnicity – The mean weight gain differs in various ethnic / racial groups
  • Parity – Lower weight gain was noted in multipara
  • Hormonal milieu – Levels of hormones like insulin and leptin can influence weight gain in pregnancy
  • Multiple pregnancy – Tend to gain more weight in multiple pregnancy
  • Hyperemesis gravidarum – Lower weight gain in women with hyperemesis gravidarum
  • Anorexia nervosa – Lower weight gain and lower birth weight in anorexic women
  • Substance abuse – Studies have found no significant difference in mean weight gain between smoking and non smoking women. But the birth weight was lower in babies born to women who were smokers.
  • Family violence – Greater risk of inadequate weight gain
  • Marital status – Many studies have found that married women were more likely to gain weight than single / divorced women

 

Foetus with anencephaly

20. Which of the following congenital malformations can be diagnosed in the first trimester ?

A. Microcephaly
B. Anencephaly
C. Meningocele
D. Encephalocele

Correct answer : B. Anencephaly

CONGENITAL MALFORMATIONS DIAGNOSED IN THE FIRST TRIMESTER

  • Routine ultrasound scan for the diagnosis of congenital anomalies is done in the second trimester
  • But in high risk cases, an early anomaly scan is done to identify major anomalies
  • The congenital anomalies that can be identified in the first trimester are:
    • Acrania – Condition in which the flat bones of the cranial vault are partially or completely absent. It is an early stage of anencephaly.
    • Exencephaly – An early stage of anencephaly in which the brain is located outside the skull
    • Anencephaly – Absence of a major part of the brain, skull and scalp. It is an anomaly that occurs when the rostral end of the neural tube fails to close.

 

21. Causes of primary amenorrhoea are all except

A. Turner syndrome
B. Sheehan’s syndrome
C. MRKH syndrome
D. Kallmann syndrome

Correct answer : B. Sheehan’s syndrome

Sheehan’s syndrome results in secondary amenorrhoea.

CAUSES OF PRIMARY AMENORRHOEA

  • Turner syndrome (45 XO)
  • Swyer syndrome (46 XY, streak gonads, female phenotype)
  • Testicular feminisation syndrome (46 XY, insensitivity to androgen, female phenotype)
  • Mullerian agenesis ( Mayer Rokitansky Kuster Hauser [MRKH] syndrome)
  • Cryptomenorrhea – Imperforate hymen / vaginal septum
  • Kallmann syndrome (Hypogonadotropic hypogonadism with hyposmia / anosmia)
  • Pituitary neoplasms

 

22. A primigravida in the first trimester of pregnancy was found to be sputum positive for acid fast bacilli. There is no prior history of tuberculosis. What is the treatment of choice for this patient?

A. Category I DOTS
B. Category II DOTS
C. Category III DOTS
D. Start ATT after delivery

Correct answer :  A. Category I DOTS

ANTI TUBERCULOSIS TREATMENT IN PREGNANCY

  • Newly smear positive cases of Tuberculosis are treated with Category I DOTS(Directly Observed Treatment Short course) in India.
  • The drugs given in category I DOTS – Isoniazid, Rifampicin, Ethambutol and Pyrazinamide are not contraindicated in pregnancy
  • But if the disease is not treated properly, it is harmful for the foetus
  • Streptomycin is not given in pregnant patients as it is teratogenic

 

23. Drug of choice for treatment of intrahepatic cholestasis in pregnancy is ?

A. Ursodeoxycholic acid

B. Dexamethasone

C. Antihistamines

D. Cholestyramine

Correct answer : A. Ursodeoxycholic acid

Ursodeoxycholic acid decreases bile salt levels and relieves pruritus. It can also decrease the chance for fetal complications.

 

24. Virus responsible for non immune hydrops foetalis is?

A. Cytomegalovirus

B. Herpes simplex virus

C. Hepatitis B virus

D. Parvovirus

Correct answer : D. Parvovirus

Parvovirus is the commonest infectious etiology for hydrops foetalis. The other viruses implicated include Cytomegalovirus, Hepatitis B virus, Herpes simplex virus, Rubella virus and Adenovirus.

 

25. Increased nuchal translucency in 13th week fetal ultrasound characteristic of ?

A. Turner syndrome

B. Down’s syndrome

C. Hydrocephalus

D. Klinefelter syndrome

Correct answer : B. Down’s syndrome

Down’s syndrome is the most common cause of increased nuchal translucency in fetal ultrasound. The other causes are Trisomy 13, Trisomy 18, Klinefelter syndrome & Turner’s syndrome.

 

26. Which of the following is a Low grade squamous intraepithelial lesion as per the Bethesda system?

A. CIN I

B. CIN II

C. CIN III

D. Squamous metaplasia

Correct answer : A. CIN I

As per the Bethesda system, CIN I is classified under Low grade squamous intraepithelial lesion and CIN II & CIN III are classified under High grade squamous intraepithelial lesion.

 

27. Which among the following is most commonly associated with carcinoma cervix?

A. HPV 35

B. HPV 33

C. HPV 18

D. HPV 16

Correct answer : D. HPV 16

HPV 16 is most commonly associated with carcinoma cervix. It is responsible for 40-70% of all invasive squamous cell cervical cancers.

 

28. Estrogen administration in a menopausal woman increases the:
a) Gonadotropin secretion
b) LDL cholesterol
c) Bone mass
d) Muscle mass
Correct answer : c) Bone mass

Estrogen increases osteoblastic activity.

 

29. Which of the following maneuvers is not used for the management of shoulder dystocia?

A. McRoberts maneuver

B. Suprapubic pressure

C. Woods corkscrew maneuver

D. Mauriceau Smellie Veit maneuver

Correct answer : D. Mauriceau Smellie Veit maneuver

  • Mauriceau Smellie Veit maneuver is used in the management of after coming head in case of breech delivery.

 What is shoulder dystocia?

  • It is a type of obstructed labour in which the anterior shoulder of the fetus fails to deliver after the emergence of the head.

Risk factors 

  • Diabetes
  • Fetal macrosomia

Procedures used in the management of shoulder dystocia

  • McRoberts maneuver – The mothers thighs are abducted and flexed onto her abdomen.
  • Rubin I maneuver (suprapubic pressure)
  • Rubin II maneuver (posterior pressure on anterior shoulder)
  • Wood’s corkscrew maneuver – This is performed only if suprapubic pressure and McRoberts maneuver are unsuccessful. Here, the posterior shoulder is rotated to anterior position.
  • Jacquemier’s maneuver (Barnum’s maneuver) – Delivery of the posterior shoulder first
  • Gaskin maneuver – Mother is moved to an all fours position with the back arched. This widens the pelivic outlet
  • Zavanelli’s maneuver
  • Cleidotomy – one or both clavicles are cut to decrease the diameter of the shoulder girdle. This is done only in case of a dead fetus / anencephalic fetus
  • Maternal symphysiotomy – the pubic symphysis of the mother is cut to facilitate the delivery of the shoulder (this is rarely used)

 

30. Decreased motility of Fallopian tube is seen associated with?

A. Noonan syndrome

B. PCOD

C. Churg Strauss syndrome

D. Kartagener’s syndrome

Correct answer: D. Kartagener’s syndrome

Ciliary motility is impaired in Kartagener’s syndrome.

 

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