CMS 2020 Paper II \u2013 Part 2 (Q41\u2013Q80)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms20p2b \u2500\u2500 *\/\n#cms20p2b *,#cms20p2b *::before,#cms20p2b *::after{box-sizing:border-box;margin:0;padding:0}\n\n#cms20p2b{\n --ter:#C0603A;--ter-light:#e8825f;--ter-pale:#fdf1ec;\n --teal:#2A7A6F;--teal-light:#3da394;--teal-pale:#eaf4f3;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#e0d8d4;--bg:#fdfaf8;--white:#ffffff;\n --correct:#1e6f46;--correct-bg:#eaf7ef;--correct-border:#43a047;\n --wrong:#b83232;--wrong-bg:#fdf0f0;--wrong-border:#e53935;\n --warn:#b85c00;--warn-bg:#fff4e5;\n --radius:10px;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;color:var(--ink);background:var(--bg);\n line-height:1.7;padding:0 0 48px;\n}\n\n\/* Sentinel *\/\n#cms20p2b 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.cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms20p2b .cq-retry-btn{\n margin-top:22px;background:transparent;border:2px solid var(--teal);\n color:var(--teal);border-radius:8px;padding:10px 28px;\n font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;\n cursor:pointer;transition:background 0.2s,color 0.2s;\n}\n#cms20p2b .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n\n@media(max-width:480px){\n #cms20p2b .cq-header h1{font-size:1.15rem}\n #cms20p2b .cq-qtext{font-size:0.88rem}\n #cms20p2b .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms20p2b\">\n\n <div class=\"cq-sentinel\" id=\"cms20p2b-sentinel\"><\/div>\n\n \n <div class=\"cq-statusbar\" id=\"cms20p2b-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms20p2b-timer-item\">\u23f1 <strong id=\"cms20p2b-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms20p2b-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms20p2b-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms20p2b-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms20p2b-sn\">0<\/strong> \/ <strong id=\"cms20p2b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms20p2b-fill\"><\/div><\/div>\n <\/div>\n\n \n <div class=\"cq-grace\" id=\"cms20p2b-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time’s Up!<\/h3>\n <p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms20p2b-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms20p2b-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n\n \n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2020<br>Paper II \u00b7 Part 2<\/h1>\n <p>Obstetrics & Gynaecology<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 41 \u2013 80<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms20p2b-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms20p2b-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms20p2b-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms20p2b-score\">\n <div class=\"cq-score-ring\" id=\"cms20p2b-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms20p2b-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms20p2b-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms20p2b-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms20p2b-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms20p2b-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms20p2b-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms20p2b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms20p2b', TOTAL=40, MAX=TOTAL*4;\n const TIMER_SECS=40*60; \/\/ 40 minutes\n const GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:41,\n stem:'Which one of the following statements regarding pre-conceptional counselling is NOT correct?',\n correct:'It is needed only in selected complicated pregnancies',\n options:['It is needed only in selected complicated pregnancies','It helps in early detection of risk factors','It helps in reducing maternal morbidity and mortality','It is a part of preventive medicine'],\n exp:'Pre-conceptional counselling is recommended for ALL women planning pregnancy \u2014 not just complicated cases. It aims to identify and modify risk factors (folic acid supplementation, rubella immunity, diabetes control, medication review) before conception, thereby reducing maternal and fetal morbidity.'\n },\n {\n id:42,\n stem:'Consider the following statements regarding Non Stress Test (NST):\\n1. Reactive NST indicates a healthy fetus\\n2. NST is an observed association of fetal breathing with fetal movements\\n3. NST has a low false negative rate (<1%) but high false positive rate (>50%)\\n4. Testing should be started at 20 weeks\\nWhich of the statement(s) given above is\/are correct?',\n correct:'1 and 3',\n options:['1 and 3','2 only','3 only','1 and 4'],\n exp:'Statement 1 (reactive NST = healthy fetus with intact CNS-cardiac axis) and statement 3 (low FNR <1% but high FPR >50% meaning many non-reactive NSTs are false alarms) are correct. Statement 2 is wrong \u2014 NST observes fetal heart rate accelerations with fetal movements (not breathing). Statement 4 is wrong \u2014 NST is typically started at 28\u201332 weeks gestation, not 20 weeks.'\n },\n {\n id:43,\n stem:'Which one of the following is a protective factor for endometrial hyperplasia?',\n correct:'Multiparity',\n options:['Diabetes','Tamoxifen therapy','Multiparity','Delayed menopause'],\n exp:'Endometrial hyperplasia results from unopposed oestrogen stimulation. Multiparity is protective \u2014 progesterone levels during multiple pregnancies provide prolonged protection. Risk factors include nulliparity, obesity, diabetes (hyperinsulinaemia drives oestrogen), tamoxifen (oestrogenic effect on endometrium), and delayed menopause (prolonged oestrogen exposure).'\n },\n {\n id:44,\n stem:'A woman who is not breast-feeding her newborn child is advised to use a contraceptive method by:',\n correct:'3rd postpartum week',\n options:['3rd postpartum week','6th postpartum week','3rd postpartum month','6th postpartum month'],\n exp:'In non-breastfeeding women, ovulation can resume as early as 25 days postpartum (typically by 4\u20136 weeks). Contraception should therefore be initiated by the 3rd postpartum week to prevent unintended pregnancy. Breastfeeding women using LAM (Lactational Amenorrhoea Method) have natural protection for up to 6 months if exclusively breastfeeding.'\n },\n {\n id:45,\n stem:'Pearl index for contraceptive effectiveness is calculated in terms of which of the following?\\n1. Pregnancy rate\\n2. Abortion rate\\n3. Hundred woman years\\n4. Thousand woman years',\n correct:'1 and 3',\n options:['1 only','2 and 3','1, 2 and 4','1 and 3'],\n exp:\"Pearl Index = (Number of pregnancies \u00d7 1200) \u00f7 (Total months of exposure) \u2014 expressed as pregnancies per 100 woman-years. It measures pregnancy rate (not abortion rate) per hundred woman-years of use. A lower Pearl Index = more effective contraceptive.\"\n },\n {\n id:46,\n stem:'Indications for removal of IUDs are all EXCEPT:',\n correct:'Cyclical menstrual bleeding',\n options:['Perforation of uterus','Cyclical menstrual bleeding','Flaring up of salpingitis','Pregnancy with IUD'],\n exp:'Cyclical menstrual bleeding is a NORMAL physiological occurrence and is NOT an indication for IUD removal. Indications for removal include: uterine perforation, pregnancy with IUD in situ, actinomycosis, severe PID\/salpingitis flare-up, and user request.'\n },\n {\n id:47,\n stem:'Contraindications for insertion of IUDs are all EXCEPT:',\n correct:'During caesarean section',\n options:['Suspected pregnancy','Trophoblastic disease','Severe dysmenorrhoea','During caesarean section'],\n exp:'IUD insertion during caesarean section (intraoperative\/immediate postpartum insertion) is actually an accepted and recommended practice \u2014 it is NOT a contraindication. WHO MEC Category 1. Suspected pregnancy, trophoblastic disease, and severe dysmenorrhoea are all contraindications to IUD insertion.'\n },\n {\n id:48,\n stem:'Which one of the following is NOT a contraindication for use of Mini pill (progestogen-only pill)?',\n correct:'Breast feeding',\n options:['Pregnancy','Breast feeding','Thromboembolic disease','History of breast cancer'],\n exp:'The mini pill (progestogen-only pill) is SAFE and recommended during breastfeeding \u2014 it does not suppress lactation unlike combined OCP. It is the contraceptive of choice in lactating women. Contraindications include current pregnancy, active thromboembolic disease, and history of breast cancer.'\n },\n {\n id:49,\n stem:'Which one of the following is the most commonly used surgical method\/technique of female sterilisation as recommended by Government of India?',\n correct:\"Pomeroy's method\",\n options:['Uchida technique','Irving method',\"Pomeroy's method\",'Madlener technique'],\n exp:\"Pomeroy's method (loop ligation and excision of mid-tubal segment) is the standard recommended technique for female sterilisation in India under the Family Planning Programme. It is simple, safe, and has a low failure rate. The Uchida and Irving methods are more complex; Madlener (crush and ligate without excision) has a higher failure rate.\"\n },\n {\n id:50,\n stem:'Which of the following is\/are required for a registered medical practitioner to qualify for performing Medical Termination of Pregnancy (MTP), as per revised MTP Act rules?\\n1. Certified for assisting at least 15 MTP in an authorised centre\\n2. Diploma or degree in Obstetrics and Gynaecology\\n3. House surgeon training for 3 months in Obstetrics and Gynaecology\\n4. Certified training for 6 months in laparoscopic surgeries',\n correct:'1, 2 and 3',\n options:['1 only','2 only','1, 2 and 3','1, 2 and 4'],\n exp:'Under the MTP Act (as amended), a registered medical practitioner qualifies by: (1) assisting at least 15 MTPs in an authorised institution, (2) holding a diploma\/degree in O&G, OR (3) completing 3-month house surgeon training in O&G. Laparoscopic surgery certification is not a listed qualifying criterion for MTP.'\n },\n {\n id:51,\n stem:'Which one of the following is NOT a support of uterus, preventing its descent?',\n correct:'Inguinal ligament',\n options:['Endopelvic fascia','Mackenrodt\\'s ligament','Inguinal ligament','Pubocervical ligament'],\n exp:\"Uterine supports: Endopelvic fascia (Level I), Mackenrodt's (cardinal\/transverse cervical) ligaments (primary support \u2014 Level II), pubocervical and uterosacral ligaments, pelvic floor muscles. The inguinal ligament runs from ASIS to pubic tubercle and is a ligament of the abdominal wall \u2014 it plays no role in supporting the uterus.\"\n },\n {\n id:52,\n stem:'As per ICMR guidelines, which one of the following statements is true regarding effects of COVID-19 on fetus according to current evidence?',\n correct:'COVID-19 virus is not teratogenic',\n options:['There is increased risk of early pregnancy loss','COVID-19 virus is not teratogenic','COVID-19 virus infection is an indication of MTP','There is increased risk of fetal growth restriction'],\n exp:'Per ICMR guidelines (2020): Current evidence does not support COVID-19 as a teratogen \u2014 there is no increased risk of fetal structural malformations. There is also no evidence of increased early pregnancy loss from SARS-CoV-2. COVID-19 infection is not an indication for MTP. Evidence on FGR was limited\/inconclusive at the time.'\n },\n {\n id:53,\n stem:'As per ICMR guidelines, which one of the following statements is true regarding COVID-19 infection in pregnancy?',\n correct:'Pregnant women with heart disease are at higher risk',\n options:['Covid-19 pneumonia in pregnancy is more severe with poor recovery','Pregnant women with heart disease are at higher risk','Vaginal secretions always test positive for COVID-19 in pregnancy','COVID-19 virus is secreted in breast milk'],\n exp:'Per ICMR guidelines: Pregnant women with comorbidities (heart disease, diabetes, hypertension, obesity) are at higher risk of severe COVID-19. COVID-19 pneumonia in pregnancy is NOT consistently more severe than in non-pregnant adults. Vaginal secretions do not always test positive. Evidence of COVID-19 in breast milk was insufficient at the time of guidelines.'\n },\n {\n id:54,\n stem:'Which one of the following is NOT a method of management of Deep Transverse Arrest with living fetus?',\n correct:'Delivery by application of forceps to the unrotated head',\n options:['Caesarean section','Delivery by ventouse','Delivery by application of forceps to the unrotated head','Manual rotation and application of forceps'],\n exp:'Deep Transverse Arrest management: (1) caesarean section, (2) ventouse (which allows rotation), (3) manual rotation followed by forceps. Applying forceps to an UNROTATED head in DTA is dangerous \u2014 forceps require the head to be in AP diameter. Kielland\\'s forceps can rotate but standard forceps on unrotated head is contraindicated.'\n },\n {\n id:55,\n stem:'Successful version of breech presentation is likely in case all of the following EXCEPT:',\n correct:'Breech with extended legs',\n options:['Breech with extended legs','Complete breech with sacro-anterior position','Non-engaged breech','Adequate amniotic fluid'],\n exp:'External cephalic version (ECV) is LESS successful with extended (frank) breech \u2014 the extended legs act as a splint, preventing flexion needed for rotation. Favourable factors: complete\/flexed breech, non-engaged breech, adequate liquor, sacro-anterior position (more room to manoeuvre). Extended legs = unfavourable for ECV.'\n },\n {\n id:56,\n stem:'Implantation of a fertilised ovum occurs on which day following fertilisation?',\n correct:'Day 6',\n options:['Day 6','Day 10','Day 14','Day 20'],\n exp:'After fertilisation in the fallopian tube, the blastocyst travels to the uterus over ~3\u20134 days, floats freely for 2\u20133 days, then implants into the endometrium on approximately day 6\u20137 post-fertilisation (day 20\u201321 of a 28-day cycle). The trophoblast begins invading the decidua by day 8\u201310.'\n },\n {\n id:57,\n stem:'During total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:',\n correct:'During division and ligation of the round ligaments',\n options:['During division and ligation of the round ligaments','During division and ligation of infundibulopelvic ligaments','During division and ligation of Mackenrodt\\'s and uterosacral ligaments','At the vaginal angles while incising the vagina to remove the cervix'],\n exp:\"The ureter is at risk at 3 sites during TAH: (1) infundibulopelvic ligament (ureter crosses at pelvic brim), (2) Mackenrodt's\/uterosacral ligaments (ureter passes 1.5 cm lateral to cervix \u2014 'water under the bridge'), (3) vaginal angles. The round ligament is divided far laterally and anteriorly \u2014 the ureter is not at risk here.\"\n },\n {\n id:58,\n stem:'The net effect of antenatal care has been the following EXCEPT:',\n correct:'Reduction in the incidence of institutional delivery',\n options:['Reduction in maternal mortality','Reduction in perinatal mortality','Reduction in the incidence of institutional delivery','Reduction in maternal morbidity'],\n exp:'Antenatal care INCREASES institutional delivery rates \u2014 by building trust, identifying high-risk pregnancies, and encouraging facility delivery. It reduces maternal mortality, perinatal mortality, and maternal morbidity. Reducing institutional delivery is the opposite of what ANC achieves and is therefore NOT a benefit of ANC.'\n },\n {\n id:59,\n stem:'Which one of the following is NOT a component of active phase in the partograph?',\n correct:'Phase of expulsion',\n options:['Acceleration phase','Phase of maximum slope','Phase of deceleration','Phase of expulsion'],\n exp:\"The active phase of labour (Friedman's curve) has three components: acceleration phase (3\u20134 cm), phase of maximum slope (4\u20139 cm \u2014 fastest progress), and deceleration phase (9\u201310 cm). The phase of expulsion refers to the second stage of labour \u2014 it is NOT part of the active phase of the first stage.\"\n },\n {\n id:60,\n stem:'From a medicolegal point of view which one of the following is NOT a sign of previous childbirth?',\n correct:'Conical cervix with round external os',\n options:['Perineum is lax and there is evidence of scarring','Introitus is gaping and there is presence of carunculae myrtiformis','Abdomen is lax and loose with striae and linea alba','Conical cervix with round external os'],\n exp:'After childbirth, the external os becomes transverse (slit-like) \u2014 NOT round. A round\/circular external os is the appearance in a nulliparous woman. Carunculae myrtiformes (remnants of torn hymen), lax perineum with scars, and lax abdomen with striae are all medicolegal signs of previous parturition.'\n },\n {\n id:61,\n stem:'The components of partograph are all EXCEPT:',\n correct:'Maternal respiratory rate',\n options:['Time','Fetal heart rate','Maternal respiratory rate','Maternal urine analysis'],\n exp:'The WHO partograph records: fetal heart rate, liquor colour, moulding, cervical dilatation, descent of head, uterine contractions (frequency\/duration\/strength), oxytocin use, drugs, maternal pulse, BP, temperature, and urine (volume, protein, acetone). Maternal respiratory rate is NOT a standard partograph component.'\n },\n {\n id:62,\n stem:'Which of the following information are provided by partograph?\\n1. Colour of liquor\\n2. Uterine contractions with duration and frequency\\n3. Dilatation of cervix',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'All three are standard components of the WHO partograph: liquor colour (clear\/meconium-stained\/absent), uterine contraction frequency and duration per 10 minutes, and cervical dilatation plotted against time with alert and action lines. All statements are correct.'\n },\n {\n id:63,\n stem:'Intraoperative recognition of ureter is by which of the following features?\\n1. Transparent tubular appearance\\n2. Pale glistening appearance\\n3. Longitudinal vessels on surface\\n4. Circumferential vessels on surface',\n correct:'2 and 4',\n options:['1 and 3','2 and 4','2 and 3','1 and 4'],\n exp:\"The ureter is recognised intraoperatively by: pale glistening white appearance, circumferential blood vessels on its surface (in contrast to the longitudinal vessels of the vas deferens), and the characteristic peristaltic 'worm-like' movement when pinched. The transparent tubular appearance describes a nerve. Longitudinal vessels are on the vas deferens.\"\n },\n {\n id:64,\n stem:'Hysterosalpingography (HSG) is least helpful in detecting which of the following?',\n correct:'Pelvic adhesions',\n options:['Tubal patency','Pelvic adhesions','Asherman syndrome','Congenital uterine anomaly'],\n exp:'HSG is excellent for assessing tubal patency, intrauterine adhesions (Asherman syndrome \u2014 filling defects), and uterine cavity shape\/congenital anomalies. However, pelvic adhesions (peritubal, periovarian, cul-de-sac) are NOT visible on HSG \u2014 they require laparoscopy for diagnosis. HSG is the LEAST helpful for pelvic adhesions.'\n },\n {\n id:65,\n stem:'Which of the following are characteristics of Trichomonas vaginitis?\\n1. Presence of greenish frothy discharge\\n2. Vaginal pH > 4.5\\n3. Presence of clue cells in microscopic examination\\n4. Strawberry spots on the vaginal mucosa',\n correct:'1, 2 and 4',\n options:['1, 2 and 3','1, 2 and 4','2, 3 and 4','1, 3 and 4'],\n exp:'Trichomonas vaginalis: frothy yellow-green discharge, vaginal pH >4.5, strawberry cervix (punctate haemorrhages = colpitis macularis), motile flagellated protozoa on wet mount. Clue cells (vaginal epithelial cells studded with bacteria) are characteristic of Bacterial Vaginosis \u2014 not Trichomonas. Statement 3 is false.'\n },\n {\n id:66,\n stem:'Tumour marker of epithelial ovarian carcinoma is:',\n correct:'CA-125',\n options:['CA-125','Alpha fetoprotein','Beta HCG','LDH'],\n exp:'CA-125 is the primary tumour marker for epithelial ovarian carcinoma (serous type especially). AFP is elevated in yolk sac tumours (germ cell), \u03b2-HCG in choriocarcinoma\/dysgerminoma, and LDH in dysgerminoma. CA-125 is used for monitoring treatment response and detecting recurrence.'\n },\n {\n id:67,\n stem:'The most common site of cervical cancer is:',\n correct:'Transformation zone',\n options:['Endocervix','Ectocervix','Transformation zone','Isthmus'],\n exp:'The transformation zone (squamocolumnar junction area) is where squamous metaplasia occurs and where HPV infection initiates carcinogenesis. Over 90% of cervical cancers arise from this zone. This is why Pap smear sampling specifically targets the transformation zone. It is not the ectocervix or endocervix per se.'\n },\n {\n id:68,\n stem:'The placenta synthesises all EXCEPT:',\n correct:'Dehydroepiandrosterone',\n options:['Oestriol','Corticotrophin releasing hormone','PAPP-A (Pregnancy Associated Plasma Protein A)','Dehydroepiandrosterone'],\n exp:'The placenta synthesises: oestriol (from DHEAS produced by fetal adrenal glands \u2014 placenta converts it), CRH, PAPP-A, hCG, HPL, progesterone. DHEA\/DHEAS (dehydroepiandrosterone) is produced by the FETAL adrenal glands and maternal adrenal glands \u2014 NOT by the placenta itself. The placenta uses DHEAS as substrate but does not synthesise it.'\n },\n {\n id:69,\n stem:'Withdrawal bleeding following administration of progesterone in a case of secondary amenorrhoea indicates all EXCEPT:',\n correct:'Defect in pituitary gland',\n options:['Absence of pregnancy','Production of endogenous oestrogen','Endometrium is responsive to oestrogen','Defect in pituitary gland'],\n exp:'Progesterone withdrawal bleeding (positive progestogen challenge test) confirms: (1) absence of pregnancy, (2) functioning endometrium responsive to oestrogen, (3) adequate endogenous oestrogen production. It does NOT indicate a pituitary defect \u2014 in fact, it excludes pituitary\/hypothalamic failure as the cause of amenorrhoea (those cases would have low oestrogen and would NOT bleed).'\n },\n {\n id:70,\n stem:'Monilial vaginitis is commonly associated with all EXCEPT:',\n correct:'Treatment of malaria with chloroquine',\n options:['Prolonged antibiotic therapy','Diabetes Mellitus','Treatment of malaria with chloroquine','Pregnancy'],\n exp:'Candidal (monilial) vaginitis is associated with: diabetes mellitus (high glucose), pregnancy (increased glycogen), prolonged antibiotic therapy (disrupts normal flora), immunosuppression, OCP use, and corticosteroids. Chloroquine treatment for malaria has no established association with vaginal candidiasis.'\n },\n {\n id:71,\n stem:'Which one of the following is NOT a risk factor for the development of placenta previa?',\n correct:'Maternal anaemia',\n options:['Maternal age','Smoking','Previous caesarean section','Maternal anaemia'],\n exp:'Placenta praevia risk factors: advanced maternal age, multiparity, previous uterine surgery (CS, myomectomy), smoking (causes placental hypertrophy), assisted conception, multiple pregnancy, previous placenta praevia. Maternal anaemia is a consequence rather than a cause of placenta praevia, and is not an independent risk factor.'\n },\n {\n id:72,\n stem:'Common clinical presentations of moderate to severe abruption are all EXCEPT:',\n correct:'Prolonged labour',\n options:['Uterine tenderness','Fetal distress','Unexplained preterm labour','Prolonged labour'],\n exp:'Abruptio placentae (moderate-severe) presents with: painful uterine tenderness (woody hard uterus), fetal distress (from uteroplacental insufficiency), concealed or revealed haemorrhage, and preterm labour (prostaglandin release). Prolonged labour is NOT a feature \u2014 abruption typically causes precipitate\/short labour or uterine hypertonus, not prolonged labour.'\n },\n {\n id:73,\n stem:'Common trisomies resulting in spontaneous abortion are all EXCEPT:',\n correct:'Trisomy 1',\n options:['Trisomy 21','Trisomy 18','Trisomy 16','Trisomy 1'],\n exp:'Trisomy 16 is the most common autosomal trisomy causing spontaneous abortion (~15% of trisomic abortions). Trisomies 21 and 18 also cause abortion but can survive to term. Trisomy 1 has NEVER been reported in a live or recognised pregnancy \u2014 chromosome 1 is the largest autosome and complete trisomy is incompatible with even early embryonic survival.'\n },\n {\n id:74,\n stem:'The initial prevention strategy for antiphospholipid syndrome will be:\\n1. Steroids\\n2. Heparin\\n3. Low dose aspirin\\n4. Progesterone support',\n correct:'2 and 3',\n options:['2 and 3','3 and 4','3 only','1 and 4'],\n exp:'For APS in pregnancy, the standard primary prevention\/treatment is low-dose aspirin (75\u2013100 mg\/day) + low molecular weight heparin. This combination reduces recurrent pregnancy loss and thrombotic events. Steroids are not routinely used (cause more harm than benefit). Progesterone support is used in threatened miscarriage, not specifically for APS.'\n },\n {\n id:75,\n stem:'Diagnostic criteria for PCOS are:\\n1. Oligo\/amenorrhoea\\n2. Hyperandrogenism\\n3. Polycystic ovaries on ultrasound',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'Per the Rotterdam criteria (2003), PCOS diagnosis requires 2 of 3 features: (1) oligo\/anovulation, (2) clinical or biochemical hyperandrogenism, (3) polycystic ovaries on ultrasound \u2014 after exclusion of other aetiologies. All three criteria together define the complete phenotype. Any 2 of 3 are sufficient for diagnosis.'\n },\n {\n id:76,\n stem:'Which of the following symptoms can be associated with pelvic organ prolapse?\\n1. Difficulty in passing urine\\n2. Incomplete evacuation of urine\\n3. Urgency and frequency',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'Pelvic organ prolapse causes a range of lower urinary tract symptoms: voiding difficulty (kinked urethra in cystocoele), incomplete bladder emptying, urgency and frequency (bladder base descent). All three symptoms are well-recognised associations. Stress incontinence may coexist or become apparent after prolapse repair.'\n },\n {\n id:77,\n stem:\"A 30-year-old lady, P2L2, presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true?\\n1. Bartholin's abscess may be the likely diagnosis\\n2. It is to be managed by marsupialisation\\n3. Gonococcus is the most common pathogenic organism\",\n correct:'1 and 2 only',\n options:['1 and 3 only','3 only','1 and 2 only','1, 2 and 3'],\n exp:\"Bartholin's abscess: painful unilateral vulval swelling at 4 or 8 o'clock position \u2014 statement 1 correct. Management of choice is marsupialisation (creates a permanent drainage pouch) \u2014 statement 2 correct. Statement 3 is false \u2014 E. coli and mixed anaerobes are the most common organisms in Bartholin's abscess today; N. gonorrhoeae causes only a minority of cases.\"\n },\n {\n id:78,\n stem:'Which one of the following is NOT a sign of separation of placenta?',\n correct:'The fundal height reduces further',\n options:['Uterus becomes globular, firm and ballotable','The fundal height reduces further','Slight bulging in the suprapubic region','Apparent lengthening of the cord with slight gush of vaginal bleeding'],\n exp:\"Signs of placental separation: uterus rises and becomes globular\/firm (Schroeder's sign), fundus RISES (not reduces \u2014 the placenta descends into lower segment pushing the uterus up), suprapubic bulge (placenta in lower segment), cord lengthening and trickle of blood (Mathews Duncan or Schultze mechanism). Fundal height RISING, not reducing, is the correct sign.\"\n },\n {\n id:79,\n stem:'Consider the following regarding examination of a rape victim:\\n1. Emergency pill is provided\\n2. Internal examination must be performed\\n3. HIV testing is done\\nWhich of the above statements is\/are correct?',\n correct:'1 and 3 only',\n options:['1 and 3 only','2 only','1, 2 and 3','3 only'],\n exp:'In rape victim management: emergency contraception (pill) is provided within 72 hours \u2014 statement 1 correct. HIV post-exposure prophylaxis and baseline HIV testing are standard \u2014 statement 3 correct. Internal examination is NOT mandatory and should ONLY be performed with informed consent and when clinically necessary \u2014 statement 2 is not universally correct as stated.'\n },\n {\n id:80,\n stem:'Consider the following cardinal movements of mechanism of normal labour:\\n1. Engagement\\n2. Internal rotation\\n3. Flexion\\n4. Restitution\\n5. Crowning\\n6. External rotation\\nWhat is the correct sequence of movements in labour in occipito-lateral position?',\n correct:'1, 3, 2, 5, 4 and 6',\n options:['1, 2, 3, 4, 5 and 6','1, 3, 2, 5, 4 and 6','2, 1, 3, 4, 5 and 6','3, 1, 2, 4, 6 and 5'],\n exp:'Cardinal movements in occipito-lateral (LOT\/ROT) position: Engagement \u2192 Descent \u2192 Flexion \u2192 Internal rotation \u2192 Crowning (extension) \u2192 Restitution \u2192 External rotation \u2192 Expulsion. So from the options: 1 (Engagement), 3 (Flexion), 2 (Internal rotation), 5 (Crowning), 4 (Restitution), 6 (External rotation) = correct sequence.'\n }\n ];\n\n function shuffle(arr){\n const a=[...arr];\n for(let i=a.length-1;i>0;i--){const j=Math.floor(Math.random()*(i+1));[a[i],a[j]]=[a[j],a[i]];}\n return a;\n }\n function esc(s){return s.replace(\/&\/g,'&').replace(\/<\/g,'<').replace(\/>\/g,'>').replace(\/\"\/g,'"')}\n\n const LETTERS=['A','B','C','D'];\n let userAnswers={}, answered=0, shuffledOpts={};\n\n \/\/ \u2500\u2500 Timer state \u2500\u2500\n let timerRunning=false, timerRemaining=TIMER_SECS, timerInterval=null, graceInterval=null;\n let quizSubmitted=false;\n\n function fmtTime(s){\n const m=Math.floor(s\/60), sec=s%60;\n return String(m).padStart(2,'0')+':'+String(sec).padStart(2,'0');\n }\n\n function startTimer(){\n if(timerRunning||quizSubmitted)return;\n timerRunning=true;\n const btn=document.getElementById(NS+'-timer-btn');\n btn.textContent='\u23f1 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Submitting in 10 Submit Now Combined Medical Services Examination 2020Paper II \u00b7 Part 2 Obstetrics & Gynaecology Questions 41 \u2013 80 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0% score Your Result \u21ba Retry Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36551","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2020 Paper-2 Part-2 - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/13\/cms-2020-paper-2-part-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2020 Paper-2 Part-2 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2020 Paper II \u2013 Part 2 (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time’s Up! 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.cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms20p2b\">\n\n <div class=\"cq-sentinel\" id=\"cms20p2b-sentinel\"><\/div>\n\n \n <div class=\"cq-statusbar\" id=\"cms20p2b-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms20p2b-timer-item\">\u23f1 <strong id=\"cms20p2b-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms20p2b-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms20p2b-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms20p2b-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms20p2b-sn\">0<\/strong> \/ <strong id=\"cms20p2b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms20p2b-fill\"><\/div><\/div>\n <\/div>\n\n \n <div class=\"cq-grace\" id=\"cms20p2b-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time’s Up!<\/h3>\n <p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms20p2b-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms20p2b-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n\n \n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2020<br>Paper II \u00b7 Part 2<\/h1>\n <p>Obstetrics & Gynaecology<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 41 \u2013 80<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms20p2b-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n\n <div class=\"cq-body\">\n <div id=\"cms20p2b-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms20p2b-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms20p2b-score\">\n <div class=\"cq-score-ring\" id=\"cms20p2b-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms20p2b-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms20p2b-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms20p2b-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms20p2b-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms20p2b-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms20p2b-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms20p2b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms20p2b', TOTAL=40, MAX=TOTAL*4;\n const TIMER_SECS=40*60; \/\/ 40 minutes\n const GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:41,\n stem:'Which one of the following statements regarding pre-conceptional counselling is NOT correct?',\n correct:'It is needed only in selected complicated pregnancies',\n options:['It is needed only in selected complicated pregnancies','It helps in early detection of risk factors','It helps in reducing maternal morbidity and mortality','It is a part of preventive medicine'],\n exp:'Pre-conceptional counselling is recommended for ALL women planning pregnancy \u2014 not just complicated cases. It aims to identify and modify risk factors (folic acid supplementation, rubella immunity, diabetes control, medication review) before conception, thereby reducing maternal and fetal morbidity.'\n },\n {\n id:42,\n stem:'Consider the following statements regarding Non Stress Test (NST):\\n1. Reactive NST indicates a healthy fetus\\n2. NST is an observed association of fetal breathing with fetal movements\\n3. NST has a low false negative rate (<1%) but high false positive rate (>50%)\\n4. Testing should be started at 20 weeks\\nWhich of the statement(s) given above is\/are correct?',\n correct:'1 and 3',\n options:['1 and 3','2 only','3 only','1 and 4'],\n exp:'Statement 1 (reactive NST = healthy fetus with intact CNS-cardiac axis) and statement 3 (low FNR <1% but high FPR >50% meaning many non-reactive NSTs are false alarms) are correct. Statement 2 is wrong \u2014 NST observes fetal heart rate accelerations with fetal movements (not breathing). Statement 4 is wrong \u2014 NST is typically started at 28\u201332 weeks gestation, not 20 weeks.'\n },\n {\n id:43,\n stem:'Which one of the following is a protective factor for endometrial hyperplasia?',\n correct:'Multiparity',\n options:['Diabetes','Tamoxifen therapy','Multiparity','Delayed menopause'],\n exp:'Endometrial hyperplasia results from unopposed oestrogen stimulation. Multiparity is protective \u2014 progesterone levels during multiple pregnancies provide prolonged protection. Risk factors include nulliparity, obesity, diabetes (hyperinsulinaemia drives oestrogen), tamoxifen (oestrogenic effect on endometrium), and delayed menopause (prolonged oestrogen exposure).'\n },\n {\n id:44,\n stem:'A woman who is not breast-feeding her newborn child is advised to use a contraceptive method by:',\n correct:'3rd postpartum week',\n options:['3rd postpartum week','6th postpartum week','3rd postpartum month','6th postpartum month'],\n exp:'In non-breastfeeding women, ovulation can resume as early as 25 days postpartum (typically by 4\u20136 weeks). Contraception should therefore be initiated by the 3rd postpartum week to prevent unintended pregnancy. Breastfeeding women using LAM (Lactational Amenorrhoea Method) have natural protection for up to 6 months if exclusively breastfeeding.'\n },\n {\n id:45,\n stem:'Pearl index for contraceptive effectiveness is calculated in terms of which of the following?\\n1. Pregnancy rate\\n2. Abortion rate\\n3. Hundred woman years\\n4. Thousand woman years',\n correct:'1 and 3',\n options:['1 only','2 and 3','1, 2 and 4','1 and 3'],\n exp:\"Pearl Index = (Number of pregnancies \u00d7 1200) \u00f7 (Total months of exposure) \u2014 expressed as pregnancies per 100 woman-years. It measures pregnancy rate (not abortion rate) per hundred woman-years of use. A lower Pearl Index = more effective contraceptive.\"\n },\n {\n id:46,\n stem:'Indications for removal of IUDs are all EXCEPT:',\n correct:'Cyclical menstrual bleeding',\n options:['Perforation of uterus','Cyclical menstrual bleeding','Flaring up of salpingitis','Pregnancy with IUD'],\n exp:'Cyclical menstrual bleeding is a NORMAL physiological occurrence and is NOT an indication for IUD removal. Indications for removal include: uterine perforation, pregnancy with IUD in situ, actinomycosis, severe PID\/salpingitis flare-up, and user request.'\n },\n {\n id:47,\n stem:'Contraindications for insertion of IUDs are all EXCEPT:',\n correct:'During caesarean section',\n options:['Suspected pregnancy','Trophoblastic disease','Severe dysmenorrhoea','During caesarean section'],\n exp:'IUD insertion during caesarean section (intraoperative\/immediate postpartum insertion) is actually an accepted and recommended practice \u2014 it is NOT a contraindication. WHO MEC Category 1. Suspected pregnancy, trophoblastic disease, and severe dysmenorrhoea are all contraindications to IUD insertion.'\n },\n {\n id:48,\n stem:'Which one of the following is NOT a contraindication for use of Mini pill (progestogen-only pill)?',\n correct:'Breast feeding',\n options:['Pregnancy','Breast feeding','Thromboembolic disease','History of breast cancer'],\n exp:'The mini pill (progestogen-only pill) is SAFE and recommended during breastfeeding \u2014 it does not suppress lactation unlike combined OCP. It is the contraceptive of choice in lactating women. Contraindications include current pregnancy, active thromboembolic disease, and history of breast cancer.'\n },\n {\n id:49,\n stem:'Which one of the following is the most commonly used surgical method\/technique of female sterilisation as recommended by Government of India?',\n correct:\"Pomeroy's method\",\n options:['Uchida technique','Irving method',\"Pomeroy's method\",'Madlener technique'],\n exp:\"Pomeroy's method (loop ligation and excision of mid-tubal segment) is the standard recommended technique for female sterilisation in India under the Family Planning Programme. It is simple, safe, and has a low failure rate. The Uchida and Irving methods are more complex; Madlener (crush and ligate without excision) has a higher failure rate.\"\n },\n {\n id:50,\n stem:'Which of the following is\/are required for a registered medical practitioner to qualify for performing Medical Termination of Pregnancy (MTP), as per revised MTP Act rules?\\n1. Certified for assisting at least 15 MTP in an authorised centre\\n2. Diploma or degree in Obstetrics and Gynaecology\\n3. House surgeon training for 3 months in Obstetrics and Gynaecology\\n4. Certified training for 6 months in laparoscopic surgeries',\n correct:'1, 2 and 3',\n options:['1 only','2 only','1, 2 and 3','1, 2 and 4'],\n exp:'Under the MTP Act (as amended), a registered medical practitioner qualifies by: (1) assisting at least 15 MTPs in an authorised institution, (2) holding a diploma\/degree in O&G, OR (3) completing 3-month house surgeon training in O&G. Laparoscopic surgery certification is not a listed qualifying criterion for MTP.'\n },\n {\n id:51,\n stem:'Which one of the following is NOT a support of uterus, preventing its descent?',\n correct:'Inguinal ligament',\n options:['Endopelvic fascia','Mackenrodt\\'s ligament','Inguinal ligament','Pubocervical ligament'],\n exp:\"Uterine supports: Endopelvic fascia (Level I), Mackenrodt's (cardinal\/transverse cervical) ligaments (primary support \u2014 Level II), pubocervical and uterosacral ligaments, pelvic floor muscles. The inguinal ligament runs from ASIS to pubic tubercle and is a ligament of the abdominal wall \u2014 it plays no role in supporting the uterus.\"\n },\n {\n id:52,\n stem:'As per ICMR guidelines, which one of the following statements is true regarding effects of COVID-19 on fetus according to current evidence?',\n correct:'COVID-19 virus is not teratogenic',\n options:['There is increased risk of early pregnancy loss','COVID-19 virus is not teratogenic','COVID-19 virus infection is an indication of MTP','There is increased risk of fetal growth restriction'],\n exp:'Per ICMR guidelines (2020): Current evidence does not support COVID-19 as a teratogen \u2014 there is no increased risk of fetal structural malformations. There is also no evidence of increased early pregnancy loss from SARS-CoV-2. COVID-19 infection is not an indication for MTP. Evidence on FGR was limited\/inconclusive at the time.'\n },\n {\n id:53,\n stem:'As per ICMR guidelines, which one of the following statements is true regarding COVID-19 infection in pregnancy?',\n correct:'Pregnant women with heart disease are at higher risk',\n options:['Covid-19 pneumonia in pregnancy is more severe with poor recovery','Pregnant women with heart disease are at higher risk','Vaginal secretions always test positive for COVID-19 in pregnancy','COVID-19 virus is secreted in breast milk'],\n exp:'Per ICMR guidelines: Pregnant women with comorbidities (heart disease, diabetes, hypertension, obesity) are at higher risk of severe COVID-19. COVID-19 pneumonia in pregnancy is NOT consistently more severe than in non-pregnant adults. Vaginal secretions do not always test positive. Evidence of COVID-19 in breast milk was insufficient at the time of guidelines.'\n },\n {\n id:54,\n stem:'Which one of the following is NOT a method of management of Deep Transverse Arrest with living fetus?',\n correct:'Delivery by application of forceps to the unrotated head',\n options:['Caesarean section','Delivery by ventouse','Delivery by application of forceps to the unrotated head','Manual rotation and application of forceps'],\n exp:'Deep Transverse Arrest management: (1) caesarean section, (2) ventouse (which allows rotation), (3) manual rotation followed by forceps. Applying forceps to an UNROTATED head in DTA is dangerous \u2014 forceps require the head to be in AP diameter. Kielland\\'s forceps can rotate but standard forceps on unrotated head is contraindicated.'\n },\n {\n id:55,\n stem:'Successful version of breech presentation is likely in case all of the following EXCEPT:',\n correct:'Breech with extended legs',\n options:['Breech with extended legs','Complete breech with sacro-anterior position','Non-engaged breech','Adequate amniotic fluid'],\n exp:'External cephalic version (ECV) is LESS successful with extended (frank) breech \u2014 the extended legs act as a splint, preventing flexion needed for rotation. Favourable factors: complete\/flexed breech, non-engaged breech, adequate liquor, sacro-anterior position (more room to manoeuvre). Extended legs = unfavourable for ECV.'\n },\n {\n id:56,\n stem:'Implantation of a fertilised ovum occurs on which day following fertilisation?',\n correct:'Day 6',\n options:['Day 6','Day 10','Day 14','Day 20'],\n exp:'After fertilisation in the fallopian tube, the blastocyst travels to the uterus over ~3\u20134 days, floats freely for 2\u20133 days, then implants into the endometrium on approximately day 6\u20137 post-fertilisation (day 20\u201321 of a 28-day cycle). The trophoblast begins invading the decidua by day 8\u201310.'\n },\n {\n id:57,\n stem:'During total abdominal hysterectomy the ureter is likely to undergo injury or ligation during the following steps EXCEPT:',\n correct:'During division and ligation of the round ligaments',\n options:['During division and ligation of the round ligaments','During division and ligation of infundibulopelvic ligaments','During division and ligation of Mackenrodt\\'s and uterosacral ligaments','At the vaginal angles while incising the vagina to remove the cervix'],\n exp:\"The ureter is at risk at 3 sites during TAH: (1) infundibulopelvic ligament (ureter crosses at pelvic brim), (2) Mackenrodt's\/uterosacral ligaments (ureter passes 1.5 cm lateral to cervix \u2014 'water under the bridge'), (3) vaginal angles. The round ligament is divided far laterally and anteriorly \u2014 the ureter is not at risk here.\"\n },\n {\n id:58,\n stem:'The net effect of antenatal care has been the following EXCEPT:',\n correct:'Reduction in the incidence of institutional delivery',\n options:['Reduction in maternal mortality','Reduction in perinatal mortality','Reduction in the incidence of institutional delivery','Reduction in maternal morbidity'],\n exp:'Antenatal care INCREASES institutional delivery rates \u2014 by building trust, identifying high-risk pregnancies, and encouraging facility delivery. It reduces maternal mortality, perinatal mortality, and maternal morbidity. Reducing institutional delivery is the opposite of what ANC achieves and is therefore NOT a benefit of ANC.'\n },\n {\n id:59,\n stem:'Which one of the following is NOT a component of active phase in the partograph?',\n correct:'Phase of expulsion',\n options:['Acceleration phase','Phase of maximum slope','Phase of deceleration','Phase of expulsion'],\n exp:\"The active phase of labour (Friedman's curve) has three components: acceleration phase (3\u20134 cm), phase of maximum slope (4\u20139 cm \u2014 fastest progress), and deceleration phase (9\u201310 cm). The phase of expulsion refers to the second stage of labour \u2014 it is NOT part of the active phase of the first stage.\"\n },\n {\n id:60,\n stem:'From a medicolegal point of view which one of the following is NOT a sign of previous childbirth?',\n correct:'Conical cervix with round external os',\n options:['Perineum is lax and there is evidence of scarring','Introitus is gaping and there is presence of carunculae myrtiformis','Abdomen is lax and loose with striae and linea alba','Conical cervix with round external os'],\n exp:'After childbirth, the external os becomes transverse (slit-like) \u2014 NOT round. A round\/circular external os is the appearance in a nulliparous woman. Carunculae myrtiformes (remnants of torn hymen), lax perineum with scars, and lax abdomen with striae are all medicolegal signs of previous parturition.'\n },\n {\n id:61,\n stem:'The components of partograph are all EXCEPT:',\n correct:'Maternal respiratory rate',\n options:['Time','Fetal heart rate','Maternal respiratory rate','Maternal urine analysis'],\n exp:'The WHO partograph records: fetal heart rate, liquor colour, moulding, cervical dilatation, descent of head, uterine contractions (frequency\/duration\/strength), oxytocin use, drugs, maternal pulse, BP, temperature, and urine (volume, protein, acetone). Maternal respiratory rate is NOT a standard partograph component.'\n },\n {\n id:62,\n stem:'Which of the following information are provided by partograph?\\n1. Colour of liquor\\n2. Uterine contractions with duration and frequency\\n3. Dilatation of cervix',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'All three are standard components of the WHO partograph: liquor colour (clear\/meconium-stained\/absent), uterine contraction frequency and duration per 10 minutes, and cervical dilatation plotted against time with alert and action lines. All statements are correct.'\n },\n {\n id:63,\n stem:'Intraoperative recognition of ureter is by which of the following features?\\n1. Transparent tubular appearance\\n2. Pale glistening appearance\\n3. Longitudinal vessels on surface\\n4. Circumferential vessels on surface',\n correct:'2 and 4',\n options:['1 and 3','2 and 4','2 and 3','1 and 4'],\n exp:\"The ureter is recognised intraoperatively by: pale glistening white appearance, circumferential blood vessels on its surface (in contrast to the longitudinal vessels of the vas deferens), and the characteristic peristaltic 'worm-like' movement when pinched. The transparent tubular appearance describes a nerve. Longitudinal vessels are on the vas deferens.\"\n },\n {\n id:64,\n stem:'Hysterosalpingography (HSG) is least helpful in detecting which of the following?',\n correct:'Pelvic adhesions',\n options:['Tubal patency','Pelvic adhesions','Asherman syndrome','Congenital uterine anomaly'],\n exp:'HSG is excellent for assessing tubal patency, intrauterine adhesions (Asherman syndrome \u2014 filling defects), and uterine cavity shape\/congenital anomalies. However, pelvic adhesions (peritubal, periovarian, cul-de-sac) are NOT visible on HSG \u2014 they require laparoscopy for diagnosis. HSG is the LEAST helpful for pelvic adhesions.'\n },\n {\n id:65,\n stem:'Which of the following are characteristics of Trichomonas vaginitis?\\n1. Presence of greenish frothy discharge\\n2. Vaginal pH > 4.5\\n3. Presence of clue cells in microscopic examination\\n4. Strawberry spots on the vaginal mucosa',\n correct:'1, 2 and 4',\n options:['1, 2 and 3','1, 2 and 4','2, 3 and 4','1, 3 and 4'],\n exp:'Trichomonas vaginalis: frothy yellow-green discharge, vaginal pH >4.5, strawberry cervix (punctate haemorrhages = colpitis macularis), motile flagellated protozoa on wet mount. Clue cells (vaginal epithelial cells studded with bacteria) are characteristic of Bacterial Vaginosis \u2014 not Trichomonas. Statement 3 is false.'\n },\n {\n id:66,\n stem:'Tumour marker of epithelial ovarian carcinoma is:',\n correct:'CA-125',\n options:['CA-125','Alpha fetoprotein','Beta HCG','LDH'],\n exp:'CA-125 is the primary tumour marker for epithelial ovarian carcinoma (serous type especially). AFP is elevated in yolk sac tumours (germ cell), \u03b2-HCG in choriocarcinoma\/dysgerminoma, and LDH in dysgerminoma. CA-125 is used for monitoring treatment response and detecting recurrence.'\n },\n {\n id:67,\n stem:'The most common site of cervical cancer is:',\n correct:'Transformation zone',\n options:['Endocervix','Ectocervix','Transformation zone','Isthmus'],\n exp:'The transformation zone (squamocolumnar junction area) is where squamous metaplasia occurs and where HPV infection initiates carcinogenesis. Over 90% of cervical cancers arise from this zone. This is why Pap smear sampling specifically targets the transformation zone. It is not the ectocervix or endocervix per se.'\n },\n {\n id:68,\n stem:'The placenta synthesises all EXCEPT:',\n correct:'Dehydroepiandrosterone',\n options:['Oestriol','Corticotrophin releasing hormone','PAPP-A (Pregnancy Associated Plasma Protein A)','Dehydroepiandrosterone'],\n exp:'The placenta synthesises: oestriol (from DHEAS produced by fetal adrenal glands \u2014 placenta converts it), CRH, PAPP-A, hCG, HPL, progesterone. DHEA\/DHEAS (dehydroepiandrosterone) is produced by the FETAL adrenal glands and maternal adrenal glands \u2014 NOT by the placenta itself. The placenta uses DHEAS as substrate but does not synthesise it.'\n },\n {\n id:69,\n stem:'Withdrawal bleeding following administration of progesterone in a case of secondary amenorrhoea indicates all EXCEPT:',\n correct:'Defect in pituitary gland',\n options:['Absence of pregnancy','Production of endogenous oestrogen','Endometrium is responsive to oestrogen','Defect in pituitary gland'],\n exp:'Progesterone withdrawal bleeding (positive progestogen challenge test) confirms: (1) absence of pregnancy, (2) functioning endometrium responsive to oestrogen, (3) adequate endogenous oestrogen production. It does NOT indicate a pituitary defect \u2014 in fact, it excludes pituitary\/hypothalamic failure as the cause of amenorrhoea (those cases would have low oestrogen and would NOT bleed).'\n },\n {\n id:70,\n stem:'Monilial vaginitis is commonly associated with all EXCEPT:',\n correct:'Treatment of malaria with chloroquine',\n options:['Prolonged antibiotic therapy','Diabetes Mellitus','Treatment of malaria with chloroquine','Pregnancy'],\n exp:'Candidal (monilial) vaginitis is associated with: diabetes mellitus (high glucose), pregnancy (increased glycogen), prolonged antibiotic therapy (disrupts normal flora), immunosuppression, OCP use, and corticosteroids. Chloroquine treatment for malaria has no established association with vaginal candidiasis.'\n },\n {\n id:71,\n stem:'Which one of the following is NOT a risk factor for the development of placenta previa?',\n correct:'Maternal anaemia',\n options:['Maternal age','Smoking','Previous caesarean section','Maternal anaemia'],\n exp:'Placenta praevia risk factors: advanced maternal age, multiparity, previous uterine surgery (CS, myomectomy), smoking (causes placental hypertrophy), assisted conception, multiple pregnancy, previous placenta praevia. Maternal anaemia is a consequence rather than a cause of placenta praevia, and is not an independent risk factor.'\n },\n {\n id:72,\n stem:'Common clinical presentations of moderate to severe abruption are all EXCEPT:',\n correct:'Prolonged labour',\n options:['Uterine tenderness','Fetal distress','Unexplained preterm labour','Prolonged labour'],\n exp:'Abruptio placentae (moderate-severe) presents with: painful uterine tenderness (woody hard uterus), fetal distress (from uteroplacental insufficiency), concealed or revealed haemorrhage, and preterm labour (prostaglandin release). Prolonged labour is NOT a feature \u2014 abruption typically causes precipitate\/short labour or uterine hypertonus, not prolonged labour.'\n },\n {\n id:73,\n stem:'Common trisomies resulting in spontaneous abortion are all EXCEPT:',\n correct:'Trisomy 1',\n options:['Trisomy 21','Trisomy 18','Trisomy 16','Trisomy 1'],\n exp:'Trisomy 16 is the most common autosomal trisomy causing spontaneous abortion (~15% of trisomic abortions). Trisomies 21 and 18 also cause abortion but can survive to term. Trisomy 1 has NEVER been reported in a live or recognised pregnancy \u2014 chromosome 1 is the largest autosome and complete trisomy is incompatible with even early embryonic survival.'\n },\n {\n id:74,\n stem:'The initial prevention strategy for antiphospholipid syndrome will be:\\n1. Steroids\\n2. Heparin\\n3. Low dose aspirin\\n4. Progesterone support',\n correct:'2 and 3',\n options:['2 and 3','3 and 4','3 only','1 and 4'],\n exp:'For APS in pregnancy, the standard primary prevention\/treatment is low-dose aspirin (75\u2013100 mg\/day) + low molecular weight heparin. This combination reduces recurrent pregnancy loss and thrombotic events. Steroids are not routinely used (cause more harm than benefit). Progesterone support is used in threatened miscarriage, not specifically for APS.'\n },\n {\n id:75,\n stem:'Diagnostic criteria for PCOS are:\\n1. Oligo\/amenorrhoea\\n2. Hyperandrogenism\\n3. Polycystic ovaries on ultrasound',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'Per the Rotterdam criteria (2003), PCOS diagnosis requires 2 of 3 features: (1) oligo\/anovulation, (2) clinical or biochemical hyperandrogenism, (3) polycystic ovaries on ultrasound \u2014 after exclusion of other aetiologies. All three criteria together define the complete phenotype. Any 2 of 3 are sufficient for diagnosis.'\n },\n {\n id:76,\n stem:'Which of the following symptoms can be associated with pelvic organ prolapse?\\n1. Difficulty in passing urine\\n2. Incomplete evacuation of urine\\n3. Urgency and frequency',\n correct:'1, 2 and 3',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'Pelvic organ prolapse causes a range of lower urinary tract symptoms: voiding difficulty (kinked urethra in cystocoele), incomplete bladder emptying, urgency and frequency (bladder base descent). All three symptoms are well-recognised associations. Stress incontinence may coexist or become apparent after prolapse repair.'\n },\n {\n id:77,\n stem:\"A 30-year-old lady, P2L2, presents with painful unilateral swelling in vulva for 3 days. Which of the following statements are true?\\n1. Bartholin's abscess may be the likely diagnosis\\n2. It is to be managed by marsupialisation\\n3. Gonococcus is the most common pathogenic organism\",\n correct:'1 and 2 only',\n options:['1 and 3 only','3 only','1 and 2 only','1, 2 and 3'],\n exp:\"Bartholin's abscess: painful unilateral vulval swelling at 4 or 8 o'clock position \u2014 statement 1 correct. Management of choice is marsupialisation (creates a permanent drainage pouch) \u2014 statement 2 correct. Statement 3 is false \u2014 E. coli and mixed anaerobes are the most common organisms in Bartholin's abscess today; N. gonorrhoeae causes only a minority of cases.\"\n },\n {\n id:78,\n stem:'Which one of the following is NOT a sign of separation of placenta?',\n correct:'The fundal height reduces further',\n options:['Uterus becomes globular, firm and ballotable','The fundal height reduces further','Slight bulging in the suprapubic region','Apparent lengthening of the cord with slight gush of vaginal bleeding'],\n exp:\"Signs of placental separation: uterus rises and becomes globular\/firm (Schroeder's sign), fundus RISES (not reduces \u2014 the placenta descends into lower segment pushing the uterus up), suprapubic bulge (placenta in lower segment), cord lengthening and trickle of blood (Mathews Duncan or Schultze mechanism). Fundal height RISING, not reducing, is the correct sign.\"\n },\n {\n id:79,\n stem:'Consider the following regarding examination of a rape victim:\\n1. Emergency pill is provided\\n2. Internal examination must be performed\\n3. HIV testing is done\\nWhich of the above statements is\/are correct?',\n correct:'1 and 3 only',\n options:['1 and 3 only','2 only','1, 2 and 3','3 only'],\n exp:'In rape victim management: emergency contraception (pill) is provided within 72 hours \u2014 statement 1 correct. HIV post-exposure prophylaxis and baseline HIV testing are standard \u2014 statement 3 correct. Internal examination is NOT mandatory and should ONLY be performed with informed consent and when clinically necessary \u2014 statement 2 is not universally correct as stated.'\n },\n {\n id:80,\n stem:'Consider the following cardinal movements of mechanism of normal labour:\\n1. Engagement\\n2. Internal rotation\\n3. Flexion\\n4. Restitution\\n5. Crowning\\n6. External rotation\\nWhat is the correct sequence of movements in labour in occipito-lateral position?',\n correct:'1, 3, 2, 5, 4 and 6',\n options:['1, 2, 3, 4, 5 and 6','1, 3, 2, 5, 4 and 6','2, 1, 3, 4, 5 and 6','3, 1, 2, 4, 6 and 5'],\n exp:'Cardinal movements in occipito-lateral (LOT\/ROT) position: Engagement \u2192 Descent \u2192 Flexion \u2192 Internal rotation \u2192 Crowning (extension) \u2192 Restitution \u2192 External rotation \u2192 Expulsion. 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Submitting in 10 Submit Now Combined Medical Services Examination 2020Paper II \u00b7 Part 2 Obstetrics & Gynaecology Questions 41 \u2013 80 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0% score Your Result \u21ba Retry Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-36551","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2020 Paper-2 Part-2 - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/04\/13\/cms-2020-paper-2-part-2\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2020 Paper-2 Part-2 - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2020 Paper II \u2013 Part 2 (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time’s Up! 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