NEET PG High Yield Questions For OBS-GYN

Mastering the NEET PG demands a strategic approach to preparation, with an emphasis on high-yield topics proving to be a successful tactic. This blog zeroes in on exactly that – a curated list of high-yield questions in OBS-GYN that are highly likely to appear on the NEET PG. By acquainting yourself with these questions and their detailed explanations, you'll deepen your understanding of OBS-GYN concepts, enhancing your confidence and readiness for exam day.

1. Identify the type of chorionicity based on the image below:

A. Dichorionic monoamniotic pregnancy

B. Monochorionic diamniotic pregnancy

C. Monochorionic monoamniotic pregnancy

D. Dichorionic diamniotic pregnancy

Correct Option: C

• The provided specimen illustrates a monochorionic-monoamniotic pregnancy.
  • A single placenta is the origin of two umbilical cords, indicating a monochorionic condition.
  • There is no amniotic membrane between the cords and the placenta.

Incorrect Options:

Option A: 

• Dichorionic monoamniotic pregnancy, where each twin has its chorion but shares a single amniotic sac, is not a biologically possible combination.

Option B:

• MCDA pregnancies have a single placenta but two separate amniotic sacs. The image doesn't match this description, as there is no visible separation between the two umbilical cords.

Option D:

• Diamniotic dichorionic must have two placentas and a thick intervening membrane composed of amnions and chorions.

2. A decision is made to perform an episiotomy to facilitate the progression of labor. An incision is made from the posterior midline of the vulva towards the anus, slightly towards the left of the midline. Which benefits does this kind of incision offer over a simple midline incision?

A. Ease of repair

B. Quick healing

C. Less blood loss

D. Less extension of the incision

Correct Option D:

Episiotomy involves widening of birth canal to facilitate delivery however it is not to be given electively for all deliveries

Midline episiotomies are easier to fix and have a smaller incidence of surgical breakdown, less pain, and lower blood loss. The incidence of dyspareunia is less. However, the incidence of extensions of the incision to include the rectum is considerably higher than with mediolateral episiotomies. Regardless of technique, attention to hemostasis and anatomic restoration is the key element of a technically appropriate repair.

Incorrect Options:

Option A: Repair of median episiotomy is easier than mediolateral episiotomy.

Option B: Healing is faster and better in median episiotomy with fewer breakdowns.

Option C: Blood loss is lesser in median episiotomy.

3. A 30-year-old patient visits the antenatal clinic at 14 weeks of pregnancy for a routine checkup. On her regular antenatal panel, she tests positive for HBsAg. Which of the following is true about her condition?

A. Significantly increased maternal morbidity

B. High risk of IUGR and IUD

C. HBsAg is the first serological marker of this illness

D. Lamivudine is the first-line drug

Correct Option:

Option C: HBsAg is the first serological marker of this illness

• The first serological marker detected in Hep B is the hepatitis B surface antigen (HBsAg), often preceding the increase in transaminase levels.
• Patient is often asymptomatic, and diagnosis is usually incidental on routine antenatal screening.

Incorrect Options:

Option A: Significantly increased maternal morbidity

• Hep B in pregnancy is not a cause of increased maternal morbidity and mortality.
• Transplacental transmission occurs and causes fetal affection usually in the perinatal period.

Option B: High risk of IUGR and IUD

• Hep B in pregnancy is not associated with an increased risk of IUGR and IUD.

Option D: Lamivudine is the first-line drug

• Lamivudine is not a drug of choice since it is associated with a high chance of developing resistant mutation. Tenofovir and Telmivudine are preferred.

4. A 26-year-old female complains of heavy vaginal bleeding. She delivered a male baby 3 days ago. She denies any pain or fever. A diagnosis of postpartum hemorrhage is made. Which of the following is not a cause of such presentation?

A. Placenta previa

B. Retained parts of the placenta

C. Endometritis

D. Placental polyp

Correct Option: A

• Placenta previa is a condition where the placenta partially or completely covers the cervix.
• While it can cause antepartum bleeding (bleeding before delivery), it is not a typical cause of postpartum hemorrhage.

Incorrect options:

Option B: Retained parts of the placenta

• Retained placental tissue after delivery can lead to postpartum hemorrhage.

Option C: Endometritis

• Endometritis is inflammation of the lining of the uterus and can lead to postpartum hemorrhage.
• Infection and inflammation compromise the normal healing process of the uterus after delivery.

Option D: Placental polyp

• A placental polyp refers to the persistence of placental tissue in the uterus after delivery.
• Similar to retained placental parts, placental polyps can cause postpartum hemorrhage.

5. Which of the following is associated with increased risk for the complication, shown below?

A. Premature rupture of membranes

B. Postpartum hemorrhage

C. Fetal exsanguination before labour

D. Fetal neural tube defects.

Correct Option C:

• The image of the placenta shows vessels from the umbilical cord traveling within the membrane unsupported (velamentous cord), while the USG image also suggests vessels from the cord near the fetal presenting part in the lower segment.

• Such findings are suggestive of velamentous cord with vasa previa.

Vasa previa

• Presence of velamentous cord at the level of Internal Os.
• Rupture of the membranes involving the overlying vessels lead to vaginal bleeding.
• As it is entirely fetal blood, this may result in fetal exsanguination and even death in more than 50% of cases.
• Diagnosis is best made by doppler

Incorrect Options:

Option A:

• There is no increased risk of PROM.

Option B:

• Vasa previa may be associated with increased risk of PPH given its association with placenta previa, but this is less likely a complication than fetal exsanguination.

Option D:

• There is no increased risk of fetal malformations with vasa previa.

Also Read: NEET PG Previous Year Question Papers of Last 6 Years

6. Which of the following is a false statement regarding this condition shown in the image?

A. Topical steroids are the mainstay of treatment.

B. It is commonly associated with insulin resistance.

C. It is often linked to obesity.

D. It is associated with PCOS.

Correct Option:

Option A- Topical steroids are the mainstay of treatment:

• Acanthosis nigricans is a skin condition characterized by dark, velvety patches of skin that usually develop in body folds and creases. It is often associated with insulin resistance, obesity, and conditions such as PCOS (Polycystic Ovary Syndrome).
• The mainstay of treatment for acanthosis nigricans involves addressing the underlying cause. If the condition is associated with insulin resistance or obesity, lifestyle modifications, weight loss, and the management of underlying metabolic conditions may be recommended.
• Topical steroids are generally not considered the mainstay of treatment for acanthosis nigricans because they may not effectively address the underlying causes of the condition. Instead, the focus is on managing the associated systemic conditions and promoting overall health.

Incorrect Options:

Option B- It is commonly associated with insulin resistance:

• Acanthosis nigricans is often associated with insulin resistance, a condition in which the body's cells do not respond properly to insulin. Insulin resistance is commonly seen in conditions like type 2 diabetes, PCOS, and obesity.

Option C- It is often linked to obesity:

• Insulin resistance is commonly associated with obesity. Excess fat, especially around the abdominal area, is linked to an increased risk of insulin resistance. Therefore, individuals with obesity are more likely to develop acanthosis nigricans.

Option D- It is associated with PCOS:

• Acanthosis nigricans is also commonly associated with PCOS, a hormonal disorder in women. PCOS is often characterized by insulin resistance, and hormonal imbalances contribute to developing acanthosis nigricans.

Also Read: How to Prepare Gynaecology and Obstetrics for Medical PG Entrance exams?

7. Review the following hysterosalpingogram and provide the appropriate diagnosis.

A. Normal uterus

B. Unicornuate uterus

C. Bicornuate uterus

D. Arcuate uterus

Correct Option:

Option B: Unicornuate uterus

• A unicornuate uterus is a rare disorder that causes a female to have only half a uterus accounting for only 10% of all Mullerian anomalies.
• Unicornuate uterus (Class II).
  • It appears banana-shaped without the rounded fundus and triangular-shaped uterine cavity. If present, the rudimentary horn presents as a soft tissue mass with similar myometrial echogenicity. Obstruction in the rudimentary horn is presented as hematometra on one side.
  • A unicornuate uterus with a non-communicating rudimentary horn is linked with several complications like infertility, endometriosis, hematometra, urinary tract anomalies, abortions, and preterm deliveries. Treatment involves surgical removal of the unicornuate uterus.

Congenital Müllerian anomalies (American Fertility Society Classification System)

• Class I (agenesis, hypoplasia). Uterus is absent in total agenesis. Partial agenesis is identified as unicornuate uterus. In hypoplasia, the endometrial cavity is small with reduced intercornual distance of less than 2 cm.
• Class II (unicornuate uterus) appears banana-shaped without the rounded fundus and triangular-shaped uterine cavity. If present, rudimentary horn presents as a soft tissue mass with similar myometrial echogenicity. Obstruction in the rudimentary horn is recognized as haematometra on one side.
• Class III (uterus didelphys). The two horns are widely separated, with no vaginal septum.
• Class IV (bicornuate uterus) shows two uterine cavities, with concave fundus, with fundal cleft greater than 1 cm, and this differentiates between the bicornuate and the septate uterus. The intercornual distance is more than 4 cm.
• Class V (septate uterus) shows a convex or flattened fundus. The intercornual distance is normal (<4 cm) and each cavity is small.
• Class VI (arcuate uterus) with no fundal indentation is of no clinical importance.

Incorrect Options:

Option A: Normal uterus

• The HSG shown above reveals a unicornuate uterus, not a normal one.
• A normal uterus shows a triangular cavity with tubes on both sides.

Option C: Bicornuate uterus

• The HSG shown above reveals a unicornuate uterus, as a bicornuate uterus appears heart-shaped, having two sides instead of a single hollow cavity.

Option D: Arcuate Uterus

• As shown above, it is a unicornuate uterus because an arcuate uterus appears as an upside-down pear with the top of the uterus indented

8. A 29-year-old woman presents to a fertility clinic with the inability to conceive for 3 years. She and her husband live together and have been married for 4 years. They are not using any contraception at present and are sexually active. Her menses are at regular 28 day intervals. Her husband is a cyclist by profession. The initial tests that should be advised to this couple are?

A.Semen analysis, CXR, Mantoux test

B. Semen analysis, Tubal patency test, Ovulation test

C. Ovulation, tubal patency, Mantoux test

D. Testicular biopsy, USG, Sperm penetration test

Correct Option:

Option B: Semen analysis, Tubal patency test, Ovulation test

• A semen analysis is essential to assess male fertility. Tubal patency tests, such as an HSG (hysterosalpingogram), can help evaluate the fallopian tubes' openness in the female partner. Ovulation tests can assess whether the woman is ovulating regularly. This combination of tests is more relevant to the evaluation of both male and female factors contributing to infertility.

Incorrect Options:

Option A: Semen analysis, CXR, Mantoux test.

• This option includes a semen analysis, which assesses the male partner's sperm parameters. However, a chest X-ray (CXR) and Mantoux test are not typically first-line tests for female infertility. CXR and Mantoux tests are more related to assessing tuberculosis exposure and are not part of routine female infertility evaluation.

Option C: Ovulation, tubal patency, Mantoux test

• This option includes assessments for ovulation and tubal patency, which are relevant to female fertility. The Mantoux test, however, is not a routine test for infertility evaluation. It is used to detect exposure to tuberculosis but is not a standard part of fertility assessments.

Option D: Testicular biopsy, USG, Sperm penetration test

• This option includes a testicular biopsy, which is not typically an initial test for male infertility unless there is a specific reason to suspect testicular issues. A scrotal ultrasound (USG) can provide information about the structure of the testicles. The sperm penetration test is not a standard first-line test for male fertility.

9. A 30-year-old female with a fibroid uterus presents at the gynecology department for infertility follow-up. She is asymptomatic and declines treatment The doctor explains possible changes that may occur in the fibroid. What is the least likely change in this patient?

A. Calcium deposition

B. Malignant change

C. Infection and hemorrhage

D. Torsion

Option B: Malignant change

• Fibroids are generally benign tumors. Malignant transformation (sarcomatous change) is a rare occurrence but is a known potential complication. However, it is considered less likely compared to other changes in fibroids.
• Intramural and submucous tumors have a higher potential for sarcomatous change than subserous tumours.
  Rare for malignant change to develop in < 40 years; more commonly seen in a postmenopausal woman.

Incorrect Options:

Option A: Calcium deposition

• Calcific degeneration (10%) usually involves the subserous fibroids with small pedicle or myomas of postmenopausal women. It is usually preceded by fatty degeneration. There is precipitation of calcium carbonate or phosphate within the tumor. When whole of the tumor is converted into a calcified mass, it is called “womb stone.”

Option C: Infection and hemorrhage

• Infection usually happens following delivery or abortion. An intramural fibroid may also be infected following delivery.

Option D: Torsion

• Torsion of a fibroid involves the twisting of its pedicle, disrupting blood supply. Torsion can lead to severe abdominal pain and is a less common but recognized complication.
• Subserous pedunculated fibroids most prone to undergo torsion.

10. 30-year-old female with a previous ultrasonography showing Rokitansky's protuberance within the right-sided ovarian cyst presents to the emergency with complaint of sudden severe abdominal pain, guarding, and rigidity. On examination, a palpable mass in the right iliac fossa is noted. The most likely diagnosis is: 

A. Torsion of subserous fibroid

B. Twisted ovarian cyst

C. Rupture of ectopic pregnancy

D. Rupture of ovarian cyst

Correct Option:

Option B- Twisted ovarian cyst:

• The woman in the scenario has a right-sided dermoid (Rokitansky protuberance) that has undergone torsion.
• Ovarian cysts, when they twist on their stalk (pedicle), can cause sudden severe abdominal pain.
• Twisted ovarian cysts may present with a palpable abdominal mass.

Ovarian torsion

• Present as a palpable mass because torsion occurs mostly in cysts that are more than 8 to 10 cm in size.
• MC tumor to show torsion: Dermoids
• C/f: Acute abdominal Pain, Fever, Vomiting
• Diagnosis: TVS Doppler showing an enlarged ovary, with or without a cyst, with venous and lymphatic engorgement, edema, and hemorrhage ovary with a twisted dilated tubular structure corresponding to vascular pedicle.
• R_x
  • Surgical Emergency Requiring Urgent Laparotomy
  • Detorsion of ovary and Ovariopexy after removal of tumor should be attempted

Incorrect Options:

Option A- Torsion of subserous fibroid:

• Subserous fibroids are benign tumors of the uterus.
• Torsion of a subserous fibroid may cause abdominal pain, but it is less common than other causes.

Option C- Rupture of ectopic pregnancy:

• A ruptured ectopic pregnancy presents with acute abdomen and any women of childbearing age presenting with such symptoms should be evaluated for a ruptured ectopic, however in this case there is a palpable abdominal mass, which is not seen in a ruptured ectopic.

Option D- Rupture of ovarian cyst:

• A ruptured ovarian cyst can also cause acute abdomen but is less common compared to a twisted ovarian cyst. In this case, this would be the next best differential.

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