In the gynaecology OPD of a district hospital, a woman with a copper IUD inserted 2 years ago has had 4 days of lower abdominal pain, fever of 38.2 °C and purulent cervical discharge. She has cervical motion tenderness and bilateral adnexal tenderness; ultrasound shows no tubo-ovarian abscess and the IUD in the correct place. Pregnancy test is negative. She can take oral drugs and wants to keep her IUD, as she does not want another pregnancy soon, and she asks whether the device must come out. What is the best plan?

Outpatient treatment, keep the IUD, review at 72 hours

Remove the IUD and rely on condoms only

Admit for IV antibiotics and remove the IUD

Remove the IUD now, then start antibiotics

In the paediatric OPD of a district hospital, a baby of 10 days, born vaginally to a mother who missed her antenatal visits, has had increasing discharge from both eyes for 4 days, first watery and now mucopurulent, with swollen eyelids. The baby is feeding well and afebrile, the chest is clear and the respiratory rate is 40/min. Gram stain of the discharge shows no Gram-negative diplococci, and Giemsa stain shows intracytoplasmic inclusions in epithelial cells. The mother has had a vaginal discharge for months but was never treated. What is the best plan?

Oral erythromycin for the baby for 14 days; treat both parents

Topical erythromycin ointment alone

Chloramphenicol eye drops; reassure the mother

Single IM ceftriaxone for the baby

HIV-1 infection is confirmed at 18 weeks in a woman at her first antenatal visit. Her CD4 count is 620 cells/mm3 and she feels well. What is the right approach under national policy?

Start lifelong ART at once, whatever the CD4 count

Single-dose nevirapine in labour only

Start ART only if CD4 falls below 350

Start ART at 28 weeks and stop after delivery

Genital tract infections, PID and breast-feeding

35 NEET-PG practice questions on Genital tract infections, PID and breast-feeding, part of Obstetrics & Gynaecology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
About vaginal discharge: 1. Normal vaginal pH in the reproductive years is about 3.8-4.5. 2. In vulvovaginal candidiasis the pH is usually above 4.5. 3. Clue cells are epithelial cells coated with coccobacilli. 4. A positive whiff test occurs in bacterial vaginosis and often in trichomoniasis. Which statements are correct?
1. A1, 3 and 4 only
2. B2 and 4 only
3. C1, 2, 3 and 4
4. D1, 2 and 3 only
Show answerHide answer
Answer: A · 1, 3 and 4 only
Lactobacilli keep the normal vaginal pH acidic, at about 3.8-4.5. Candidiasis usually leaves the pH normal (under 4.5), while bacterial vaginosis and trichomoniasis raise it above 4.5; both may release amines and give a fishy odour with KOH. Clue cells are the hallmark of BV.
- B: Statement 2 is wrong, and statements 1 and 3 are correct.
- C: Statement 2 is wrong, so not all four are correct.
- D: Statement 2 is wrong; the pH stays normal in candidiasis.
Remember this
Candidiasis keeps a normal acidic pH; BV and trichomoniasis raise it above 4.5.
Question 2 · Hard
In the gynaecology OPD of a district hospital, a woman with a copper IUD inserted 2 years ago has had 4 days of lower abdominal pain, fever of 38.2 °C and purulent cervical discharge. She has cervical motion tenderness and bilateral adnexal tenderness; ultrasound shows no tubo-ovarian abscess and the IUD in the correct place. Pregnancy test is negative. She can take oral drugs and wants to keep her IUD, as she does not want another pregnancy soon, and she asks whether the device must come out. What is the best plan?
1. ARemove the IUD and rely on condoms only
2. BOutpatient treatment, keep the IUD, review at 72 hours
3. CAdmit for IV antibiotics and remove the IUD
4. DRemove the IUD now, then start antibiotics
Show answerHide answer
Answer: B · Outpatient treatment, keep the IUD, review at 72 hours
This is mild to moderate PID without an abscess in a woman who can take oral drugs, so outpatient treatment is appropriate. Removing the IUD does not improve outcomes, so it can stay if she wishes, provided she is reviewed within 72 hours; it is removed if she does not improve.
- A: Removal is unnecessary, and condoms alone give her less protection than she wants.
- C: An IUD alone is not a reason for admission or removal.
- D: Routine removal does not speed recovery and exposes her to unwanted pregnancy.
Remember this
PID in an IUD user: treat with antibiotics and leave the IUD in; remove it only if there is no improvement in 48-72 hours.
Question 3 · Hard
In the paediatric OPD of a district hospital, a baby of 10 days, born vaginally to a mother who missed her antenatal visits, has had increasing discharge from both eyes for 4 days, first watery and now mucopurulent, with swollen eyelids. The baby is feeding well and afebrile, the chest is clear and the respiratory rate is 40/min. Gram stain of the discharge shows no Gram-negative diplococci, and Giemsa stain shows intracytoplasmic inclusions in epithelial cells. The mother has had a vaginal discharge for months but was never treated. What is the best plan?
1. ATopical erythromycin ointment alone
2. BChloramphenicol eye drops; reassure the mother
3. CSingle IM ceftriaxone for the baby
4. DOral erythromycin for the baby for 14 days; treat both parents
Show answerHide answer
Answer: D · Oral erythromycin for the baby for 14 days; treat both parents
Onset at 5-14 days with Giemsa inclusion bodies is chlamydial ophthalmia neonatorum from an untreated maternal infection. Topical treatment alone is inadequate because the nasopharynx is colonised and pneumonia may follow, so the baby needs oral erythromycin for 14 days (or azithromycin), watching for pyloric stenosis, and both parents are treated.
- A: Topical treatment does not clear nasopharyngeal carriage or prevent pneumonia.
- B: Chloramphenicol drops do not treat chlamydia, and the parents need treatment.
- C: A single dose of ceftriaxone treats gonococcal, not chlamydial, ophthalmia.
Remember this
Chlamydial conjunctivitis in a newborn: systemic erythromycin and treatment of both parents.
Question 4 · Medium
In pelvic inflammatory disease, which of these are indications for admission and IV antibiotics? 1. Pregnancy. 2. Tubo-ovarian abscess. 3. Presence of an intrauterine device. 4. No improvement on oral therapy within 72 hours. Choose the correct answer:
1. A1, 2, 3 and 4
2. B1 and 3 only
3. C2 and 4 only
4. D1, 2 and 4 only
Show answerHide answer
Answer: D · 1, 2 and 4 only
Admission is advised when a surgical emergency cannot be excluded, with a tubo-ovarian abscess, in pregnancy, with severe illness or high fever, when oral treatment cannot be taken, or when there is no response to oral therapy. An IUD alone is not an indication for admission or for removal.
- A: Statement 3 is wrong; an IUD alone does not require admission.
- B: Statement 3 is wrong, and statements 2 and 4 are correct.
- C: Statement 1 is also correct; pregnancy needs admission.
Remember this
Admit PID for abscess, pregnancy, severe illness, intolerance or failure of oral treatment; an IUD alone is not a reason.
Question 5 · Medium
HIV-1 infection is confirmed at 18 weeks in a woman at her first antenatal visit. Her CD4 count is 620 cells/mm3 and she feels well. What is the right approach under national policy?
1. ASingle-dose nevirapine in labour only
2. BStart ART only if CD4 falls below 350
3. CStart ART at 28 weeks and stop after delivery
4. DStart lifelong ART at once, whatever the CD4 count
Show answerHide answer
Answer: D · Start lifelong ART at once, whatever the CD4 count
Under the treat-all policy, every pregnant woman with HIV starts lifelong antiretroviral therapy as soon as she is diagnosed, whatever her CD4 count or clinical stage. Early viral suppression is what prevents most mother-to-child transmission, and the baby also receives antiretroviral prophylaxis after birth.
- A: Single-dose nevirapine is an outdated, much weaker regimen.
- B: CD4 thresholds no longer decide when ART starts.
- C: Late, time-limited ART is an outdated approach and less effective.
Remember this
HIV in pregnancy: start lifelong ART at diagnosis, irrespective of CD4 count.
Question 6 · Medium
After a stillbirth at 36 weeks, the mother asks for help to stop her milk. She has no hypertension or pre-eclampsia. Which drug is preferred?
1. ABromocriptine for 14 days
2. BPyridoxine for 7 days
3. COral oestrogen for 1 week
4. DCabergoline 1 mg single dose
Answer and explanation in LearnFree account
Question 7 · Medium
About female genital tuberculosis: 1. The fallopian tubes are involved in almost all cases. 2. Spread is usually haematogenous from a focus elsewhere, often the lungs. 3. Endometrial biopsy is best taken in the early proliferative phase. 4. HSG may show beaded tubes and a tobacco-pouch appearance. Which are correct?
1. A1, 2 and 3 only
2. B1, 2 and 4 only
3. C2, 3 and 4 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 8 · Medium
Right upper quadrant pain that is worse on breathing, with fever, develops in a woman being treated for chlamydial cervicitis. Liver enzymes and gallbladder ultrasound are normal. Laparoscopy would most likely show:
1. AMultiple small liver abscesses
2. BViolin-string adhesions from liver capsule to diaphragm
3. CA subphrenic collection of pus
4. DA thick-walled, distended gallbladder with impacted stones
Answer and explanation in LearnFree account
Question 9 · Easy
VDRL is reactive at 1:32 and TPHA positive at the first antenatal visit at 14 weeks. What is the treatment?
1. AAzithromycin 2 g orally once
2. BBenzathine penicillin G 2.4 million units IM
3. CDoxycycline 100 mg twice daily for 14 days
4. DCeftriaxone 1 g IM daily for 10 days
Answer and explanation in LearnFree account
Question 10 · Medium
Ultrasound of a tender, fluctuant 3 cm swelling in the breast of a mother 3 weeks after delivery shows a fluid collection; she has had antibiotics for mastitis for 48 hours. What is the preferred treatment?
1. AOpen incision and drainage under general anaesthesia
2. BStop breastfeeding and give cabergoline
3. CChange to IV antibiotics alone
4. DUltrasound-guided needle aspiration with antibiotics
Answer and explanation in LearnFree account
Question 11 · Easy
Wet mount of a thin, grey, fishy-smelling vaginal discharge (pH 5.0) shows epithelial cells studded with coccobacilli. What is the diagnosis?
1. AVulvovaginal candidiasis
2. BAtrophic vaginitis
3. CTrichomoniasis
4. DBacterial vaginosis
Answer and explanation in LearnFree account
Question 12 · Medium
Pap smear report: Actinomyces-like organisms, in a woman with no symptoms who has had a copper IUD for 4 years; pelvic examination is normal. What should be done?
1. ARemove the IUD and give penicillin
2. BGive doxycycline for 14 days
3. CReassure and leave the IUD in place
4. DRemove the IUD and repeat the smear
Answer and explanation in LearnFree account
Question 13 · Medium
Amenorrhoea for a year, after previously regular periods, in a woman being evaluated for infertility; pregnancy test is negative and FSH, prolactin and TSH are normal. No withdrawal bleed follows either progestogen or combined oestrogen-progestogen. Hysteroscopy shows dense adhesions, and biopsy of the remaining endometrium shows epithelioid granulomas with Langhans giant cells; Xpert MTB/RIF detects rifampicin-sensitive M. tuberculosis. What is the next step?
1. AInsert an IUD and give high-dose oestrogen
2. BLaparoscopic salpingectomy
3. CA 6-month course of anti-tubercular therapy
4. DHysteroscopic adhesiolysis at once
Answer and explanation in LearnFree account
Question 14 · Medium
As the medical officer of a PHC with no laboratory, you see a woman with abnormal vaginal discharge, no lower abdominal pain and a healthy-looking cervix. Under the national syndromic approach, her treatment should cover:
1. AGonococcal and chlamydial cervicitis, without vaginitis
2. BHerpes simplex and lymphogranuloma
3. CSyphilis and chancroid as for ulcers
4. DBacterial vaginosis, trichomoniasis and candidiasis
Answer and explanation in LearnFree account
Question 15 · Easy
On day 12 after delivery, a mother has a painful, red, wedge-shaped area in the upper outer left breast with fever of 38.6 °C and no fluctuant mass. Which organism is most likely, and should she keep breastfeeding?
1. AStreptococcus pyogenes; stop breastfeeding
2. BEscherichia coli; express and discard milk
3. CCandida albicans; stop on that side
4. DStaphylococcus aureus; continue breastfeeding
Answer and explanation in LearnFree account
Question 16 · Hard
Hysterosalpingography a year after completing 6 months of ATT for genital TB shows bilateral cornual blocks. Hysteroscopy shows a normal cavity and endometrium, AMH is 2.4 ng/mL, and her husband's semen analysis is normal. What is the best way to achieve pregnancy?
1. ALaparoscopic tubal cannulation and adhesiolysis
2. BIntrauterine insemination for 6 cycles
3. CIn vitro fertilisation and embryo transfer
4. DA second 6-month course of ATT
Answer and explanation in LearnFree account
Question 17 · Medium
Chlamydia trachomatis is detected on a first-trimester screening swab in a pregnant woman without symptoms. Which treatment is preferred, and what follow-up is advised?
1. ADoxycycline for 7 days; no retest
2. BErythromycin for 3 days; retest after delivery
3. CAzithromycin 1 g once; test of cure in 4 weeks
4. DAzithromycin 1 g once; no retest needed
Answer and explanation in LearnFree account
Question 18 · Medium
Postmenopausal for 8 years, a woman has vaginal dryness, burning and painful intercourse. The vaginal walls are pale and smooth, pH is 6.0 and the smear shows mainly parabasal cells with no organisms. What is the best treatment?
1. ALow-dose vaginal oestrogen
2. BClotrimazole pessaries
3. COral metronidazole
4. DSystemic combined HRT
Answer and explanation in LearnFree account
Question 19 · Easy
Lactational amenorrhoea method gives over 98% protection when three conditions are met. Which set is correct?
1. AAny feeding pattern, baby under 6 months
2. BAmenorrhoea, partial breastfeeding, baby under 1 year
3. CAmenorrhoea, full breastfeeding, baby under 6 months
4. DFull breastfeeding, baby under 9 months
Answer and explanation in LearnFree account
Question 20 · Hard
Copper-coloured macules on the palms and soles, with RPR 1:64 and a positive TPHA, are found in a pregnant woman at 24 weeks. She had hives and wheeze after a penicillin injection as a child, and skin testing confirms penicillin allergy. What is the best treatment?
1. AOral erythromycin for 14 days
2. BDesensitise, then give benzathine penicillin
3. COral azithromycin 2 g single dose
4. DOral doxycycline for 14 days
Answer and explanation in LearnFree account
Question 21 · Easy
Which part of the female genital tract is involved most often in genital tuberculosis?
1. AFallopian tubes
2. BEndometrium
3. COvaries
4. DCervix
Answer and explanation in LearnFree account
Question 22 · Hard
In the labour room triage at night, a primigravida at 34 weeks reports 3 days of painful vulval blisters and ulcers, dysuria, fever and tender inguinal nodes. She has never had such lesions before, and her husband says he has never had genital sores. PCR of a swab from the ulcer base detects HSV-2, and type-specific serology shows no HSV-2 IgG. The membranes are intact and she is not in labour, and fetal growth and heart rate are normal. She asks how her baby can be born safely. What is the best plan?
1. AInduce labour at 37 weeks once lesions heal
2. BOral aciclovir now and planned caesarean section
3. CCaesarean only if lesions are present in labour
4. DOral aciclovir now and vaginal birth at term
Answer and explanation in LearnFree account
Question 23 · Medium
On the third day after a caesarean, both breasts of a mother are hard, swollen, warm and tender, and the baby struggles to latch; temperature is 37.6 °C, with no localised redness. What is the best management?
1. AOral cloxacillin for 7 days
2. BStop feeding for 48 hours
3. CTight binder and less fluid
4. DFrequent feeds with hand expression
Answer and explanation in LearnFree account
Question 24 · Medium
HBsAg is positive and HBeAg negative in a mother who has just delivered a healthy term baby at a district hospital. Which plan is correct for the newborn?
1. AVaccine within 12 hours; HBIG not needed; breastfeed freely
2. BHBIG only, with formula feeding
3. CHepatitis B vaccine and HBIG within 12 hours; breastfeed
4. DVaccine at 6 weeks; avoid breastfeeding
Answer and explanation in LearnFree account
Question 25 · Easy
Frothy, greenish-yellow, foul vaginal discharge with itching and punctate haemorrhages on the cervix; the wet mount shows motile flagellated organisms. Besides metronidazole for her, what else is essential?
1. AColposcopy of the cervical lesions
2. BVaginal douching with povidone-iodine
3. CRepeat wet mount weekly for a month
4. DTreat her sexual partner at the same time
Answer and explanation in LearnFree account

10 more Genital tract infections, PID and breast-feeding questions

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Genital tract infections, PID and breast-feeding

In pelvic inflammatory disease, which of these are indications for admission and IV antibiotics? 1. Pregnancy. 2. Tubo-ovarian abscess. 3. Presence of an intrauterine device. 4. No improvement on oral therapy within 72 hours. Choose the correct answer:

HIV-1 infection is confirmed at 18 weeks in a woman at her first antenatal visit. Her CD4 count is 620 cells/mm3 and she feels well. What is the right approach under national policy?

After a stillbirth at 36 weeks, the mother asks for help to stop her milk. She has no hypertension or pre-eclampsia. Which drug is preferred?

Right upper quadrant pain that is worse on breathing, with fever, develops in a woman being treated for chlamydial cervicitis. Liver enzymes and gallbladder ultrasound are normal. Laparoscopy would most likely show:

VDRL is reactive at 1:32 and TPHA positive at the first antenatal visit at 14 weeks. What is the treatment?

Ultrasound of a tender, fluctuant 3 cm swelling in the breast of a mother 3 weeks after delivery shows a fluid collection; she has had antibiotics for mastitis for 48 hours. What is the preferred treatment?

Wet mount of a thin, grey, fishy-smelling vaginal discharge (pH 5.0) shows epithelial cells studded with coccobacilli. What is the diagnosis?

Pap smear report: Actinomyces-like organisms, in a woman with no symptoms who has had a copper IUD for 4 years; pelvic examination is normal. What should be done?

As the medical officer of a PHC with no laboratory, you see a woman with abnormal vaginal discharge, no lower abdominal pain and a healthy-looking cervix. Under the national syndromic approach, her treatment should cover:

On day 12 after delivery, a mother has a painful, red, wedge-shaped area in the upper outer left breast with fever of 38.6 °C and no fluctuant mass. Which organism is most likely, and should she keep breastfeeding?

Hysterosalpingography a year after completing 6 months of ATT for genital TB shows bilateral cornual blocks. Hysteroscopy shows a normal cavity and endometrium, AMH is 2.4 ng/mL, and her husband's semen analysis is normal. What is the best way to achieve pregnancy?

Chlamydia trachomatis is detected on a first-trimester screening swab in a pregnant woman without symptoms. Which treatment is preferred, and what follow-up is advised?

Postmenopausal for 8 years, a woman has vaginal dryness, burning and painful intercourse. The vaginal walls are pale and smooth, pH is 6.0 and the smear shows mainly parabasal cells with no organisms. What is the best treatment?

Lactational amenorrhoea method gives over 98% protection when three conditions are met. Which set is correct?

Copper-coloured macules on the palms and soles, with RPR 1:64 and a positive TPHA, are found in a pregnant woman at 24 weeks. She had hives and wheeze after a penicillin injection as a child, and skin testing confirms penicillin allergy. What is the best treatment?

Which part of the female genital tract is involved most often in genital tuberculosis?

On the third day after a caesarean, both breasts of a mother are hard, swollen, warm and tender, and the baby struggles to latch; temperature is 37.6 °C, with no localised redness. What is the best management?

HBsAg is positive and HBeAg negative in a mother who has just delivered a healthy term baby at a district hospital. Which plan is correct for the newborn?

Frothy, greenish-yellow, foul vaginal discharge with itching and punctate haemorrhages on the cervix; the wet mount shows motile flagellated organisms. Besides metronidazole for her, what else is essential?