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LEVEL 1 NEXT MCQS

OBSTETRICS AND GYNAECOLOGY
KONCPT NEXT, NEET PG/SS COACHING CENTRE
1.31 year old G3P0A3 woman is counseled to have on HSG for further evaluation of
recurrent pregnancy loss and infertility ?she has had three prior miscarriages requiring
dilatation and curettage. Otherwise ,she is healthy . she has been attempting pregnancy
for 13 months. Which of the following is the HSG likely to reveal given her history?
A.Unicornuate uterus
B.Proximal tubal obstruction
C.Intrauterine synechiae
D.Distal tubal obstruction
Correct answer:C. Intrauterine synechiae
Option C:Intrauterine synechiae also known as ASHERMAN’S SYNDROME. Charecterised by

presence of scar tissue within endometrial cavity. Causes includes
1. curettage (repeated) following MTP or PPH
2. tuberculosis
3. schistosomiasis
Hysterosalpingography involve injection of radio opaque dye through the uterus with
fluoroscopic visualization of uterine cavity and tubal lumen.
Option A(Incorrect): Unicornuate uterus – it is a type of Mullerian duct Anomaly. Uterus is

formed from only one pair of mullerian duct while the other mullerian duct does not
develop or only in a rudimentary fasion.
Option B (Incorrect): Proximal tubal obstruction-10% -25% cause of tubal infertility.

Option D(Incorrect): Distal tubal obstruction-85% cause of tubal infertility.
Although other options –option A,B and D are cause for infertility, in given question woman
is able to conceive ,making anomalous uterus ,tubal obstruction less likely.
Reference: speroff clinical gynaecologic , endocrinology and infertility ;eighth edition,

chapter 27

2. A 39-year-old woman, gravida 2, para 1, at 30-weeks gestation comes to the physician

for a prenatal visit. The patient's due date was determined by a 7-week ultrasound. Her
prenatal course has been unremarkable. She has no complaints of contractions, loss of
fluid, or bleeding from the vagina, and her baby is moving well. Examination
demonstrates a fetal heart rate of 150 and a fundal height of 27 centimeters, which is the
same measurement as that determined 4 weeks ago. This patient's fundal height
measurement is most suggestive of which of the following?
A. Inaccurate estimated date of delivery (due date)
B. Intrauterine growth restriction
C. Premature labor
D. Twin gestation
Correct answer-B.Intrauterine growth restriction

Fundal height measurement is performed by placing a measuring tape on the
pubic symphysis and measuring to the top of the fundus. Between the gestational ages of 18
to 34 weeks, there is a rough correlation between weeks of gestation and fundal height in
centimeters. For example,a woman at 26 weeks' gestation should have a fundal height that
is roughly 26 centimeters.
Option-B(Correct)-This patient is at 30 weeks' gestation and has a fundal height of 27

centimeters. Furthermore, and perhaps more importantly, there has been no change in the
fundal height over the past four weeks. These findings are concerning for intrauterine
growth restriction (IUGR). IUGR is a disorder in which the fetus is not growing appropriately.
It is most commonly defined as an estimated fetal weight less than the 10th percentile for a
given gestational age. Given that this patient's fundal height does not appear to have
increased over the past 4 weeks and that it is 3 centimeters less than expected, IUGR is of
concern and this patient should be sent for an ultrasound to evaluate fetal size.
Option-A(Incorrect)-This patient is unlikely to have an inaccurate estimated date of delivery

(due date) because her due date was determined by a 7-week ultrasound. Ultrasound dating
of a pregnancy is more accurate the earlier in pregnancy that it is performed and a 7-week
ultrasound is considered excellent for establishing a due date.
Option C(Incorrect)- Premature labor would not be a concern in this patient with no
contractions and no other symptoms.
Option D(Incorrect)- A twin gestation should have been seen on the 7-week ultrasound.
Furthermore, a fundal height that is less than the gestational age would predict makes twins
less likely.
Reference: Williams obstetrics 24 th edition, chapter 44
3. A 16-year-old girl is brought to clinic by her mother with concerns regarding the lack of
any signs of puberty. The appearance of external genitalia is of a normal prepubertal
female. Laboratory studies show markedly elevated FSH and LH levels. Which of the

following causes of delayed puberty accompanies elevated circulating gonadotropin

levels?
A. hypothalamic tumors
B. gonadal dysgenesis
C. Kallmann syndrome
D. malnutrition
Correct answer- B-Gonadal dysgenesis

Puberty is delayed when secondary sex development fails to occur by 13 years of age in girls
or no testicular growth
by 14 years in boys. Low circulating sex steroid levels delay epiphyseal closure, leading to
prolonged
growth of extremities. Delayed puberty results from the absence of either gonadal or
hypothalamic–
pituitary function.
Option B(Correct)- Absence of gonadal function due to defective gonadal development

(gonadal
dysgenesis) leads to a rise in circulating gonadotropin levels (hyper-gonadotropic
hypogonadism)
because negative feedback restraint is removed from the hypothalamus and pituitary.
Absence of pulsatile GnRH due to hypothalamic suppression causes a decline in circulating

gonadotropin levels (hypogonadotropic hypogonadism). Suppression of hypothalamic GnRH
may
reflect the presence of
Option A(Incorrect)- Central nervous system (CNS) tumors and diseases.

Option D(Incorrect)- Malnutrition.
Option C(Incorrect)- Kallmann syndrome refers to GnRH deficiency, combined with
anosmia due to olfactory bulb agenesis. This syndrome may be due to a defect in migration
of GnRH-containing neurons from the nasal placode to the hypothalamus.

Reference: Berek and Novak’s gynaecology, fifteenth edition, chapter 29.
4. A 27-year-old woman, gravida 2, para 2, comes to the physician to have her staples
removed after an elective repeat cesarean delivery. Her pregnancy course was
uncomplicated. She states that she is doing well except that since the delivery she has
noticed some episodes of sadness and tearfulness. She is eating and sleeping normally and
has no strange thoughts or thoughts of hurting herself or others. Physical examination is
within normal limits for a patient who is status post cesarean delivery. Which of the
following is the most likely diagnosis?
A. Maternity blues
B. Postpartum depression
C. Postpartum mania
D. Post partum psychosis
Correct answer A.Maternity blues.
Option A(Correct): A. Maternity blues is the term used to describe a common postpartum
reaction that occurs in 50 to 70% of postpartum patients. It is characterized by tearfulness,
restlessness, and anxiety. Symptoms typically start in the first few days postpartum and
resolve within 2 weeks but certain patients continue to have the symptoms for several
weeks. Many symptoms may be seen in association with this disorder including headache,
backache, fatigue, forgetfulness, insomnia, weeping, depression, anxiety, and negative
feelings toward the newborn infant. Interestingly, another component of the syndrome may
be episodes of elation, and such mood lability can be especially distressing for the new
mother. Etiology is unclear. Certainly, the postpartum period with a newborn can be
stressful and life changing, which can certainly lead to mood changes and a number of
emotional responses. Some researchers have argued that changes in hormone levels are at
the root of the maternity blues, but this has never been definitively proven. This patient
does not have evidence of a true postpartum depression (e.g., insomnia, lack of appetite, or

anhedonia) or postpartum psychosis (e.g., bizarre thoughts) and she does not have any
thoughts of hurting herself or her baby. Therefore, the most likely diagnosis is maternity
blues and she should be given support and reassurance ,hospitalization not required usually.
Option B(Incorrect): Postpartum depression is a depression that occurs in about 10% of

postpartum women and it is more serious than the maternity blues. Symptoms may include
sleep disturbances and changes in appetite. Hospitalization is required.
Option C(Incorrect): Postpartum mania is characterised by decreased need for

sleep,increased activity, speech and impulsive choices and disorganized behavior. It occurs
in about 10% of postpartum women. Hospitalisation is required.
Option D(Incorrect): postpartum psychosis is a psychiatric disorder that occurs in about 1

per 1,000 deliveries. It is characterized by severe anxiety, agitation, disordered thoughts,
and confusion. Hospitalization is required.
Reference : Williams obstetrics 24 th edition, chapter 37
5.A 58-year-old woman develops postmenopausal bleeding. An endometrial biopsy shows

adenocarcinoma. She undergoes a total abdominal hysterectomy with pelvic lymph node
sampling. Thefinal pathology shows tumor extending from the uterus into the cervix but
no other invasion (see image below).
Lymph nodes were negative for metastasis. The cancer is classified as which stage?
Image:
A. I
B.) II
C. III
D. IV
Correct answer is option B: stage 2. Adenocarcinoma of the endometrium with extension to

the cervix is a stage II lesion.

From the above table ,it is clear that option A(STAGE 1) is incorrect which implies
myometrial invasion.
Option C(STAGE 3) is incorrect which implies lymph node involvement.
Option D(STAGE 4) is incorrect which implies tumour invading into adjacent organs.
Reference: Berek and Novak’s gynaecology, fifteenth edition, chapter 35.







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KONCPT NEXT/NEET PG/SS COACHING CENTRE OG BY DR.

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LEVEL 1 NEXT MCQS

Correct answer:C. Intrauterine synechiae

Option C:Intrauterine synechiae also known as ASHERMAN’S SYNDROME. Charecterised by

Option A(Incorrect): Unicornuate uterus – it is a type of Mullerian duct Anomaly. Uterus is

Option B (Incorrect): Proximal tubal obstruction-10% -25% cause of tubal infertility.

Reference: speroff clinical gynaecologic , endocrinology and infertility ;eighth edition,

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2. A 39-year-old woman, gravida 2, para 1, at 30-weeks gestation comes to the physician

Correct answer-B.Intrauterine growth restriction

Option-B(Correct)-This patient is at 30 weeks' gestation and has a fundal height of 27

Option-A(Incorrect)-This patient is unlikely to have an inaccurate estimated date of delivery

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following causes of delayed puberty accompanies elevated circulating gonadotropin

Correct answer- B-Gonadal dysgenesis

Option B(Correct)- Absence of gonadal function due to defective gonadal development

Absence of pulsatile GnRH due to hypothalamic suppression causes a decline in circulating

Option A(Incorrect)- Central nervous system (CNS) tumors and diseases.

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Reference: Berek and Novak’s gynaecology, fifteenth edition, chapter 29.

Correct answer A.Maternity blues.

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Option B(Incorrect): Postpartum depression is a depression that occurs in about 10% of

Option C(Incorrect): Postpartum mania is characterised by decreased need for

Option D(Incorrect): postpartum psychosis is a psychiatric disorder that occurs in about 1

Reference : Williams obstetrics 24 th edition, chapter 37

5.A 58-year-old woman develops postmenopausal bleeding. An endometrial biopsy shows

Correct answer is option B: stage 2. Adenocarcinoma of the endometrium with extension to

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Reference: Berek and Novak’s gynaecology, fifteenth edition, chapter 35.

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