CMS 2023 | General Medicine & Paediatrics | Paper I | Part A<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n*,*::before,*::after{box-sizing:border-box;margin:0;padding:0}\n:root{\n --blue:#1A5EA8;--blue-lt:#2E82D5;--blue-pale:#EBF3FD;\n --navy:#1A3A5C;--navy-lt:#24527F;--navy-pale:#E8F0F9;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#dde4ed;--bg:#f8fafd;--white:#ffffff;\n --ok:#1e6f46;--ok-bg:#eaf7ef;--ok-bd:#43a047;\n --bad:#b83232;--bad-bg:#fdf0f0;--bad-bd:#e53935;\n --rad:10px;\n}\nbody{font-family:\"Source Serif 4\",Georgia,serif;font-size:16px;background:var(--bg);color:var(--ink);line-height:1.7;min-height:100vh}\n#cms23p2b{max-width:780px;margin:0 auto;padding:0 0 60px}\n\n\/* \u2500\u2500 progress strip (sticky within page, below any WP header) \u2500\u2500 *\/\n.qz-prog-bar{\n position:sticky;top:0;z-index:200;\n 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Display\",serif;font-size:1.15rem;color:var(--bad);margin-bottom:8px}\n.qz-grace-box p{font-size:0.85rem;color:var(--ink-mid);margin-bottom:14px}\n.qz-grace-n{font-family:\"Playfair Display\",serif;font-size:2.8rem;font-weight:700;color:var(--bad);line-height:1;margin-bottom:16px}\n.qz-grace-now{background:var(--bad);color:#fff;border:none;border-radius:8px;padding:10px 24px;font-family:\"Playfair Display\",serif;font-size:0.9rem;font-weight:700;cursor:pointer}\n.qz-grace-now:hover{background:#c62828}\n\n@media(max-width:480px){\n .qz-header h1{font-size:1.05rem}\n .qz-stem{font-size:0.87rem}\n .qz-opt-txt{font-size:0.84rem}\n .qz-prog-stats{font-size:0.68rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms23p2b\">\n\n<div class=\"qz-prog-bar\" id=\"qz-prog-bar\">\n <div class=\"qz-prog-stats\">\n <div class=\"qz-stat\">✓️ <strong id=\"qz-sc\">0<\/strong><\/div>\n <div class=\"qz-stat\">❌ <strong id=\"qz-sw\">0<\/strong><\/div>\n <div class=\"qz-stat\">⏳ <strong id=\"qz-sr\">40<\/strong> left<\/div>\n <div class=\"qz-timer-wrap\">\n <div class=\"qz-timer\" id=\"qz-timer\">⏱ <strong id=\"qz-td\">40:00<\/strong><\/div>\n <div class=\"qz-stat net-score\">Net <strong id=\"qz-sn\">0<\/strong> \/ 160<\/div>\n <\/div>\n <\/div>\n <div class=\"qz-prog-track\"><div class=\"qz-prog-fill\" id=\"qz-fill\"><\/div><\/div>\n<\/div>\n\n<div class=\"qz-grace\" id=\"qz-grace\">\n <div class=\"qz-grace-box\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"qz-grace-n\" id=\"qz-gn\">10<\/div>\n <button class=\"qz-grace-now\" id=\"qz-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-header\">\n <h1>Combined Medical Services Examination 2023<br>Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part B<\/h1>\n <p>Obstetrics · Gynaecology · Family Planning · Reproductive Medicine<\/p>\n <div class=\"qz-meta\">\n <span class=\"qz-badge\">Questions 41–80<\/span>\n <span class=\"qz-badge\">Options reshuffled<\/span>\n <span class=\"qz-badge\">Score = c × 4 − w<\/span>\n <button class=\"qz-timer-btn\" id=\"qz-tbtn\">⏱ Start Timed Mode<\/button>\n <\/div>\n<\/div>\n\n<div class=\"qz-body\">\n <div id=\"qz-questions\"><\/div>\n <div class=\"qz-submit-wrap\">\n <button class=\"qz-submit\" id=\"qz-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"qz-result\" id=\"qz-result\">\n <div class=\"qz-ring\" id=\"qz-ring\">\n <div class=\"qz-ring-inner\">\n <div class=\"qz-ring-pct\" id=\"qz-rpct\">0%<\/div>\n <div class=\"qz-ring-sub\">score<\/div>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"qz-net\" id=\"qz-rnet\"><\/div>\n <div class=\"qz-verdict\" id=\"qz-rv\"><\/div>\n <div class=\"qz-bands\">\n <span class=\"qz-band bc\" id=\"qz-bc\"><\/span>\n <span class=\"qz-band bw\" id=\"qz-bw\"><\/span>\n <span class=\"qz-band bs\" id=\"qz-bs\"><\/span>\n <\/div>\n <button class=\"qz-retry\" id=\"qz-retry\">↺ Retry Quiz<\/button>\n <\/div>\n<\/div>\n\n<\/div>\n\n<script>\n(function(){\n\nvar TOTAL = 40, MAX = 160;\nvar TSECS = 2400, GSECS = 10;\nvar LTRS = [\"A\",\"B\",\"C\",\"D\"];\n\nvar QQ = [\n{id:41,\nstem:\"The daily requirement of iron during second half of pregnancy is\",\ncorrect:\"20 mg per day\",\nopts:[\"2 mg per day\",\"6 mg per day\",\"10 mg per day\",\"20 mg per day\"],\nexp:\"Iron requirements increase dramatically during pregnancy due to: expansion of maternal red cell mass (approximately 450 mg), fetal iron requirement (approximately 300 mg), placental iron (approximately 50 mg), and delivery losses. Daily requirements: non-pregnant woman: 2 mg\/day; first trimester: 2-4 mg\/day; second half of pregnancy (second and third trimester): 6-8 mg elemental iron per day absorbed, but the dietary requirement accounting for absorption efficiency is approximately 20 mg per day (since only about 20-30% of dietary iron is absorbed). The Government of India and WHO recommend supplementation with 100-200 mg elemental iron daily in the second half of pregnancy. Among the options, 20 mg per day reflects the absorbed\/supplemental requirement standard in Indian obstetric examinations.\"\n},\n{id:42,\nstem:\"Carbohydrate metabolism in normal pregnancy shows\",\ncorrect:\"Fasting hypoglycaemia\",\nopts:[\"Fasting hypoglycaemia\",\"Postprandial hypoglycaemia\",\"Increased sensitivity of insulin receptors in mother\",\"Decreased plasma glucagon levels\"],\nexp:\"Normal pregnancy is characterised by diabetogenic changes to ensure adequate glucose supply for the fetus. Key metabolic changes: (1) Fasting hypoglycaemia (correct answer) - due to continuous placental glucose transfer to the fetus, maternal fasting glucose levels are lower than in non-pregnant state (accelerated starvation); (2) Postprandial hyperglycaemia (NOT hypoglycaemia) - diabetogenic hormones (hPL, progesterone, cortisol, glucagon) cause insulin resistance, leading to higher post-meal glucose levels; (3) DECREASED insulin sensitivity\/insulin resistance (not increased sensitivity) - due to anti-insulin hormones (hPL is the main one); (4) Increased plasma glucagon levels. The hallmark is: fasting hypoglycaemia + postprandial hyperglycaemia, creating the diabetogenic state of pregnancy.\"\n},\n{id:43,\nstem:\"A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following?<br>1. Hb less than 10gm%<br>2. PCV less than 30%<br>3. MCHC more than 30%<br>4. Microcytic hypochromic picture on peripheral blood smear (PBS)<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Iron deficiency anaemia (IDA) in pregnancy - laboratory findings: (1) Hb less than 10 g% (WHO defines anaemia in pregnancy as Hb less than 11 g\/dL; severe anaemia in India is Hb less than 7 g\/dL; Hb less than 10 g% is a commonly used threshold for IDA in Indian obstetric examinations) - statement 1 correct. (2) PCV (haematocrit) less than 30% (normal in pregnancy is approximately 33-38%; below 30% indicates significant anaemia) - statement 2 correct. (3) MCHC MORE than 30%: this statement is incorrect. In IDA, MCHC is LOW (less than 30-32 g\/dL) because the red cells are poorly haemoglobinised (hypochromic). MCHC above 30% would be normal or seen in spherocytosis, NOT IDA. (4) Microcytic hypochromic picture on PBS - classic morphology of IDA - statement 4 correct. Statements 1, 2, and 4 are correct.\"\n},\n{id:44,\nstem:\"Which of the following are the clinical features of molar pregnancy?<br>1. History of amenorrhoea and vaginal bleeding<br>2. Patient has excessive vomiting<br>3. History of expulsion of grape-like vesicles<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Hydatidiform mole (molar pregnancy) is a gestational trophoblastic disease with characteristic clinical features: (1) Amenorrhoea followed by vaginal bleeding (statement 1) - brownish PV bleeding (prune juice appearance) in the first trimester is the most common presenting symptom; (2) Hyperemesis (excessive vomiting, statement 2) - due to markedly elevated beta-hCG levels stimulating hypothalamic vomiting centres; occurs more severely than in normal pregnancy; (3) Expulsion of grape-like vesicles (statement 3) - pathognomonic of molar pregnancy; the characteristic grape-like translucent vesicles (hydropic villi) may be expelled per vaginum. Other features: uterus larger than dates, absent fetal heart sounds, snowstorm pattern on ultrasound, markedly elevated beta-hCG. All three statements are correct.\"\n},\n{id:45,\nstem:\"Which of the following vaccines can be given to a pregnant woman?<br>1. COVID vaccine<br>2. Measles, Mumps, Rubella vaccine<br>3. Hepatitis B vaccine<br>4. Rabies vaccine<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Vaccines in pregnancy - safe vs contraindicated: SAFE in pregnancy (inactivated\/killed vaccines, toxoids, subunit vaccines): TT\/Td (tetanus, mandatory in antenatal care), Hepatitis B (statement 3 correct), Influenza (inactivated), COVID-19 vaccines (mRNA and adenoviral vector vaccines are recommended for pregnant women per WHO\/CDC\/IAP, statement 1 correct), Rabies (post-exposure prophylaxis can be given in pregnancy, statement 4 correct), Pneumococcal, Meningococcal. CONTRAINDICATED in pregnancy (live attenuated vaccines): MMR (Measles, Mumps, Rubella) - statement 2 INCORRECT - live attenuated viral vaccine with theoretical teratogenic risk; women should avoid pregnancy for 1 month after MMR vaccination. Varicella, Yellow fever (avoid unless high risk), BCG, Oral typhoid (Ty21a), OPV. Statements 1, 3, and 4 are correct.\"\n},\n{id:46,\nstem:\"Which of the following are the characteristics of true labour pains?<br>1. Intensity and duration of contractions increase progressively<br>2. Progressive effacement and dilatation of the cervix<br>3. Formation of the bag of forewaters<br>4. Pain is confined to lower abdomen and groin<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"True labour pains vs false labour (Braxton Hicks) contractions: True labour pain characteristics: (1) Contractions increase progressively in intensity, duration (from 20-30 sec to 60-90 sec), and frequency (from 15-20 min apart to 2-3 min apart) - statement 1 correct. (2) Progressive effacement (thinning) and dilatation of the cervix - this is the DEFINING feature of true labour; Braxton Hicks do not cause cervical change - statement 2 correct. (3) Formation of the bag of forewaters (forewater bag\/forebag) - the lower pole of the membranes bulges into the cervical os as it dilates - statement 3 correct. (4) In TRUE labour, pain typically starts in the BACK and radiates to the lower abdomen and groin (NOT confined to lower abdomen); pain confined only to lower abdomen without back component may be false labour. Statement 4 is not the characteristic of true labour. Statements 1, 2, and 3 are correct.\"\n},\n{id:47,\nstem:\"Which are the parts of active management of third stage of labour?<br>1. Injection oxytocin 10 units IM within 1 minute of delivery of baby<br>2. Injection oxytocin 10 units IM at the birth of first twin in twin pregnancy<br>3. Controlled cord traction<br>4. Delayed cord clamping as per indications<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Active Management of Third Stage of Labour (AMTSL) - current WHO\/FIGO components: (1) Uterotonic administration: Oxytocin 10 IU IM (or IV) within 1 minute of delivery of the baby (statement 1 correct) - this is the MOST IMPORTANT component. (2) In twin pregnancy, oxytocin should be given after delivery of the LAST twin (not the first twin) - statement 2 is INCORRECT; giving oxytocin after the first twin would contract the uterus and compromise the second twin. (3) Controlled cord traction (CCT\/Brandt-Andrews method) - statement 3 correct - gentle traction on the cord while applying suprapubic counter-pressure to deliver the placenta. (4) Delayed cord clamping is NOW recommended as part of neonatal care (beneficial for the neonate) but is NOT traditionally listed as part of AMTSL for preventing PPH. Statements 1 and 3 are the core AMTSL components; among the options, 1, 2, and 3 is the closest answer per this examination.\"\n},\n{id:48,\nstem:\"Which of the following are correct regarding acute mastitis?<br>1. It usually occurs in first 2-4 weeks postpartum.<br>2. Microscopic examination of breast milk shows leukocyte count more than 10^6\/mL and bacterial count more than 10^3\/mL.<br>3. Common organisms are bacteroids, E. coli and Klebsiella.<br>4. The source of infection is infant's nose and throat.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Lactation mastitis (puerperal mastitis): Statement 1 TRUE: Acute puerperal mastitis most commonly occurs in the first 2-6 weeks postpartum (peak 2-4 weeks), affecting approximately 10% of breastfeeding women. Statement 2 TRUE: WHO diagnostic criteria for mastitis include: leukocytes greater than 10^6\/mL and bacterial count greater than 10^3\/mL in breast milk. Statement 3 FALSE: The most common causative organism is Staphylococcus aureus (responsible for approximately 80-90% of cases, including MRSA), NOT Bacteroides, E. coli, or Klebsiella. These gram-negative organisms cause mastitis in non-puerperal or neonatal mastitis. Statement 4 TRUE: The primary source of S. aureus infection is the infant's nose, throat, and skin; the infant colonises the nipple via suckling, and bacteria enter through cracks\/fissures. Statements 1, 2, and 4 are correct.\"\n},\n{id:49,\nstem:\"As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), tear of greater than 50% of External Anal Sphincter is of degree\",\ncorrect:\"3b\",\nopts:[\"3c\",\"2c\",\"3b\",\"3a\"],\nexp:\"RCOG (2007) classification of obstetric anal sphincter injuries (OASI): First degree: injury to perineal skin only. Second degree: injury involving perineal muscles but not the anal sphincter. Third degree: injury to the perineum involving the anal sphincter complex - subdivided as: 3a: Less than 50% thickness of external anal sphincter (EAS) torn; 3b: MORE than 50% thickness of EAS torn; 3c: Both EAS and internal anal sphincter (IAS) torn. Fourth degree: injury involving the anal sphincter complex AND anal epithelium\/rectal mucosa. A tear involving greater than 50% of the EAS is classified as 3b. This classification is important as it guides surgical repair and prognosis; 3b and 3c injuries require meticulous overlapping sphincter repair by a trained surgeon.\"\n},\n{id:50,\nstem:\"What are the causes of lactation failure after delivery?<br>1. Infrequent suckling<br>2. Depression or anxiety state in the puerperium<br>3. Prolactin inhibition<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Lactation failure (insufficient milk production) after delivery - causes: (1) Infrequent suckling (statement 1): Prolactin release is a neuroendocrine reflex triggered by nipple suckling. Infrequent or inadequate suckling reduces prolactin pulses and milk production. Demand-supply: more suckling = more milk. (2) Depression or anxiety in the puerperium (statement 2): Psychological stress, postnatal depression, and anxiety inhibit oxytocin release (milk let-down reflex), reducing effective milk transfer and leading to engorgement and eventual lactation failure. (3) Prolactin inhibition (statement 3): Any cause of hypoprolactinaemia (e.g., Sheehan syndrome\/pituitary necrosis after PPH, dopamine agonists like bromocriptine, cabergoline) causes lactation failure by removing the hormonal drive for milk synthesis. All three statements are correct causes of lactation failure.\"\n},\n{id:51,\nstem:\"Secondary arrest of dilatation during the process of labour may be due to which of the following factors?<br>1. Poor uterine contractions<br>2. Cessation of cervical dilatation despite strong uterine contractions<br>3. Disproportion and malpresentation<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Secondary arrest of dilatation (secondary arrest of cervical dilatation) occurs after the active phase of labour has been established (usually after 4 cm dilatation) and dilatation then stops for 2 or more hours. Causes: (1) Poor uterine contractions\/uterine inertia (hypotonic uterine dysfunction) - the most common cause; inadequate power is the first thing to correct (statement 1 correct). (2) Cessation of cervical dilatation despite strong contractions (statement 2) suggests an abnormality of the passenger or passage, not power - this is how secondary arrest may present clinically. (3) Disproportion (cephalopelvic disproportion, CPD) and malpresentation (e.g., brow presentation, deep transverse arrest) - obstruction to the descent and rotation of the presenting part causes arrest despite adequate uterine contractions (statement 3 correct). All three are causes of secondary arrest of dilatation.\"\n},\n{id:52,\nstem:\"First stage of labour starts from\",\ncorrect:\"the onset of true labour pains and ends with the full dilatation of cervix\",\nopts:[\"full dilatation of cervix to the expulsion of the fetus from the birth canal\",\"maternal bearing down efforts and ends with the delivery of the baby\",\"the onset of true labour pains and ends with the full dilatation of cervix\",\"the formation of bag of waters\"],\nexp:\"The three stages of labour: FIRST STAGE: From the onset of true labour pains (regular, progressive uterine contractions causing cervical effacement and dilatation) to full dilatation of the cervix (10 cm). It has two phases: latent phase (0-4 cm, slow dilatation) and active phase (4-10 cm, rapid dilatation approximately 1 cm\/hour in primigravida, 1.5 cm\/hour in multigravida). SECOND STAGE: From full dilatation of the cervix to the delivery\/expulsion of the baby. It includes the descent, rotation, and delivery of the fetal head and body. THIRD STAGE: From delivery of the baby to expulsion of the placenta and membranes. Option (c) correctly defines the first stage of labour.\"\n},\n{id:53,\nstem:\"Vesicovaginal fistula is classified as complicated if it has which of the following features?<br>1. Size - more than 3 cm<br>2. Bladder involvement - Supratrigonal<br>3. Location - Midvaginal<br>4. Presence of prior radiation<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Classification of vesicovaginal fistula (VVF) as complicated (associated with poorer surgical outcomes and requiring specialist management): Features of COMPLICATED VVF: (1) Large size (greater than 3 cm) - statement 1 correct; larger fistulae are more difficult to repair and have higher failure rates. (2) Supratrigonal location (involving the bladder trigone, ureterovaginal involvement, or near the ureteral orifices) - statement 2 correct; trigonal involvement risks ureteral injury during repair. (3) Midvaginal location alone is NOT a complicating feature; it is the juxtacervical or trigonal location that matters - statement 3 is NOT a complicating criterion. (4) Prior radiation (radiation-induced VVF) - statement 4 correct; irradiated tissues are poorly vascularised, avascular, and heal poorly, making repair extremely challenging. Statements 1, 2, and 4 are features of complicated VVF.\"\n},\n{id:54,\nstem:\"Which of the following set of muscles collectively form the muscle Levator Ani that forms the pelvic floor?<br>1. Ischiococcygeus<br>2. Pubococcygeus<br>3. Sacrococcygeus<br>4. Iliococcygeus<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"The levator ani is the principal muscle of the pelvic floor. It is a broad, thin muscle formed by the fusion of three muscle components: (1) Pubococcygeus (statement 2 correct) - arises from the posterior surface of the pubic body, passes posteriorly to insert into the anococcygeal raphe and coccyx; includes the puborectalis and pubovaginalis subdivisions. (2) Iliococcygeus (statement 4 correct) - arises from the arcus tendineus levator ani (thickened obturator fascia) and the ischial spine, inserts into the anococcygeal raphe and coccyx. (3) Ischiococcygeus\/Coccygeus (statement 1 correct) - technically the coccygeus is sometimes considered a separate muscle from the levator ani, but in clinical\/examination contexts it is often included as a component of the pelvic diaphragm. Sacrococcygeus (statement 3) is NOT a component of the levator ani; it is a vestigial muscle of the dorsal surface of the sacrum. Statements 1, 2, and 4 are correct.\"\n},\n{id:55,\nstem:\"Blood supply to the uterus comes from which of the following arteries?<br>1. Ovarian artery<br>2. Vaginal artery<br>3. Uterine artery<br>4. Inferior vesical artery<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Blood supply to the uterus: Primary supply: (1) Uterine artery (statement 3 correct) - a branch of the anterior division of the internal iliac artery; it is the MAIN blood supply to the uterus, ascending along the lateral wall and giving branches to the uterine body, cervix, and upper vagina. (2) Ovarian artery (statement 1 correct) - a branch of the abdominal aorta; it anastomoses with the uterine artery at the uterine cornu to supply the fundus and fallopian tube. (3) Vaginal artery (statement 2 correct) - a branch of the internal iliac artery; supplies the cervix and upper vagina, anastomosing with the uterine artery. Inferior vesical artery (statement 4) supplies the bladder and lower ureter, NOT the uterus. The azygos arteries of the vagina arise from the uterine and vaginal arteries, not the inferior vesical. Statements 1, 2, and 3 are correct.\"\n},\n{id:56,\nstem:\"Which one of the following is a prerequisite for Endometrial Ablation?\",\ncorrect:\"Woman who prefers to preserve her uterus\",\nopts:[\"Uterus is 12-14 weeks size\",\"Woman wants to preserve her reproductive function\",\"Fibroids > 3 cm in size\",\"Woman who prefers to preserve her uterus\"],\nexp:\"Endometrial ablation is a minimally invasive procedure that destroys the endometrium to reduce or eliminate heavy menstrual bleeding (menorrhagia). The procedure is indicated for women who: have completed their family (do not desire future fertility - this is a PREREQUISITE, not to preserve reproductive function), prefer uterus preservation to avoid hysterectomy, and have failed medical management. Prerequisites\/indications: (a) Uterus 12-14 weeks size is a contraindication (too large for the procedure). (b) Desire to preserve REPRODUCTIVE function is an ABSOLUTE CONTRAINDICATION (ablation destroys the endometrium, making successful implantation extremely unlikely and causing serious complications in any subsequent pregnancy). (c) Fibroids greater than 3 cm are a relative contraindication as they distort the cavity. (d) Woman who prefers to PRESERVE HER UTERUS (but not her fertility) - this is the correct prerequisite\/indication for ablation as an alternative to hysterectomy.\"\n},\n{id:57,\nstem:\"Which of the following day of menstrual cycle is best for endometrial sampling to diagnose ovulation?\",\ncorrect:\"21st - 23rd day\",\nopts:[\"8th - 10th day\",\"12th - 14th day\",\"16th - 20th day\",\"21st - 23rd day\"],\nexp:\"Endometrial biopsy for diagnosing ovulation (and assessing luteal phase adequacy) should be timed to the mid-luteal phase, approximately 7-10 days after expected ovulation. In a standard 28-day menstrual cycle: Ovulation occurs on day 14. Luteal phase: days 15-28. Mid-luteal phase (peak progesterone effect on endometrium): days 21-23. Endometrial sampling on days 21-23 shows secretory changes (dating of the endometrium by Noyes criteria), with glandular secretions, stromal oedema, and sub-nuclear vacuoles progressing to supra-nuclear secretions. A secretory endometrium on days 21-23 confirms ovulation has occurred. Earlier biopsies (days 8-14) show proliferative endometrium regardless of ovulation. Days 16-20 may show early secretory changes. Days 21-23 is optimal for confirming ovulation.\"\n},\n{id:58,\nstem:\"A 27-year-old female married for 3 years regularly cohabiting with husband presents to Gynaecology OPD with complaints of inability to conceive for 2 years. During clinical evaluation hysterosalpingography was done which revealed irregular outline of uterine cavity and rigid fallopian tubes with nodulations. Most likely cause for this condition is\",\ncorrect:\"Genital Tuberculosis\",\nopts:[\"Genital Herpes\",\"Syphilis\",\"Genital Tuberculosis\",\"Gonorrhoea\"],\nexp:\"The hysterosalpingography (HSG) findings described are pathognomonic of genital tuberculosis (TB): (1) Irregular outline of the uterine cavity - endometrial TB causes irregular filling defects, synechiae (Asherman-like pattern), and the classic triangular or calcified uterine cavity; (2) Rigid fallopian tubes with nodulations - salpingitis isthmica nodosa pattern; stiff, straight (pipe-stem) tubes without peristalsis; beaded or nodular appearance due to caseous deposits; (3) The combination of tubal rigidity (lack of normal tortuous appearance) with uterine cavity irregularity in a sub-fertile woman in the Indian subcontinent strongly points to genital TB. Genital TB is the most important cause of tubal infertility in developing countries. Treatment: standard ATT regimen. Gonorrhoea can cause tubal damage but the nodular rigid pattern with uterine cavity irregularity is characteristic of TB.\"\n},\n{id:59,\nstem:\"NACO (National AIDS Control Organization) in India works towards which of the following causes?<br>1. Screening high risk cases of HIV<br>2. Facilitating adoption of orphans<br>3. Public education towards safe sex<br>4. Treating HIV cases free of cost<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"NACO (National AIDS Control Organisation) was established in 1992 under the Ministry of Health and Family Welfare, Government of India. NACO's mandate and activities include: (1) Screening high risk groups for HIV (Integrated Counselling and Testing Centres, ICTC; targeted interventions for bridge populations) - statement 1 correct. (2) Facilitating adoption of orphans is NOT part of NACO's mandate; adoption is handled by CARA (Central Adoption Resource Authority) under the Ministry of Women and Child Development - statement 2 incorrect. (3) Public education and awareness campaigns for safe sex (IEC - Information, Education, Communication activities; condom promotion; behaviour change communication) - statement 3 correct. (4) Providing free ART (antiretroviral therapy) treatment through ART centres across India under the National AIDS Control Programme - statement 4 correct. Statements 1, 3, and 4 are correct.\"\n},\n{id:60,\nstem:\"Prophylactic oophorectomy is recommended in high risk women with which of the following?<br>1. Carrying BRCA1 or BRCA2 genes<br>2. Family history of breast, colon, ovarian cancer<br>3. Patients having tubo-ovarian abscess<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 2 only\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is recommended in high-risk women: (1) BRCA1\/BRCA2 mutation carriers (statement 1 correct): BRCA1 carriers have 40-46% lifetime risk of ovarian cancer; BRCA2 carriers have 10-27% risk. RRBSO reduces ovarian cancer risk by 80-96% and breast cancer risk by approximately 50% when done before menopause. Recommended typically between age 35-40 for BRCA1 and 40-45 for BRCA2. (2) Strong family history of breast, colon (Lynch syndrome\/HNPCC), or ovarian cancer (statement 2 correct) - Lynch syndrome carries 10-12% lifetime risk of ovarian cancer; prophylactic surgery is recommended. (3) Tubo-ovarian abscess (TOA) - this is an acute infection requiring antibiotics and drainage; it is NOT an indication for prophylactic oophorectomy (it is treated medically or with surgical drainage, not prophylactic removal). Statements 1 and 2 are correct.\"\n},\n{id:61,\nstem:\"Schiller-Duval body is a characteristic histological feature of which one of the following cancers?\",\ncorrect:\"Endodermal sinus tumour\",\nopts:[\"Dysgerminoma\",\"Endodermal sinus tumour\",\"Non-gestational ovarian choriocarcinoma\",\"Sex cord stromal tumours\"],\nexp:\"Schiller-Duval bodies (also called glomeruloid bodies) are a pathognomonic histological feature of ENDODERMAL SINUS TUMOUR (EST, also known as yolk sac tumour) of the ovary. They are perivascular structures resembling primitive glomeruli: a central capillary surrounded by tumour cells, enclosed within a space lined by tumour cells - resembling the Duval-Schiller glomerulus of the rodent yolk sac. EST is a highly malignant ovarian germ cell tumour occurring in young women and girls (median age 18 years), secreting alpha-fetoprotein (AFP) - used as a tumour marker for diagnosis and monitoring. Treatment: BEP chemotherapy (bleomycin, etoposide, cisplatin). Schiller-Duval bodies are NOT seen in dysgerminoma (large cells with fibrous septa and lymphocytic infiltration), choriocarcinoma, or sex cord stromal tumours.\"\n},\n{id:62,\nstem:\"Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele?\",\ncorrect:\"Gartner's cyst is not reducible\",\nopts:[\"Marked cough impulse in Gartner's cyst\",\"Margins are ill-defined in Gartner's cyst\",\"There is no impulse on coughing in cystocele\",\"Gartner's cyst is not reducible\"],\nexp:\"Gartner's cyst vs Cystocele differentiation: Gartner's duct cyst is a remnant of the mesonephric (Wolffian) duct, appearing as a cystic swelling in the antero-lateral wall of the vagina. Key distinguishing feature: Gartner's cyst is NOT REDUCIBLE (it is a true cyst with its own wall, fixed in the vaginal wall - does not reduce with pressure or change in position). Cystocele is a herniation of the bladder through the anterior vaginal wall. Cystocele IS reducible (the bladder can be pushed back into the pelvis with digital pressure). Both may show a cough impulse (the cystocele shows a marked cough impulse as the bladder is pushed forward; Gartner's cyst may also transmit some cough impulse but it is the non-reducibility that is the KEY distinguishing feature). Option (d) Gartner's cyst is not reducible is the correct distinguishing feature.\"\n},\n{id:63,\nstem:\"Surgical treatment by ventrosuspension of uterus is used for what condition?\",\ncorrect:\"Retroversion of uterus\",\nopts:[\"Pelvic organ prolapse\",\"Retroversion of uterus\",\"Rupture of uterus\",\"Vault prolapse\"],\nexp:\"Ventrosuspension (ventrofixation) of the uterus is a surgical procedure in which the round ligaments are shortened and\/or the uterus is sutured to the anterior abdominal wall to correct symptomatic retroversion of the uterus. Retroversion of the uterus (posterior tilt of the uterine body) may cause dysmenorrhoea, dyspareunia, backache, and pelvic pain in symptomatic cases. The procedure artificially maintains the uterus in an anteverted position. Note: ventrosuspension is now rarely performed as most retroversions are asymptomatic and mobile, and the procedure does not treat the underlying cause. Manchester repair and other procedures are used for prolapse. Surgical repair is used for uterine rupture. Sacrocolpopexy is used for vault prolapse. Ventrosuspension specifically treats retroversion of the uterus.\"\n},\n{id:64,\nstem:\"A 29-year-old female with 3 months amenorrhoea presents to gynaecology OPD with complaints of something coming out of her vagina. On clinical evaluation she was found to have single live pregnancy with second degree uterine prolapse. Which one of the following is the best management plan for her?\",\ncorrect:\"Reassurance\",\nopts:[\"Reassurance\",\"Cervical amputation\",\"Cerclage operation\",\"Pessary treatment\"],\nexp:\"Uterine prolapse complicating pregnancy is managed conservatively during pregnancy. In a young pregnant woman (29 years) with a desired single live pregnancy and second-degree uterine prolapse: (1) REASSURANCE is the appropriate management during pregnancy. As the pregnancy advances, the enlarging uterus naturally rises into the abdomen, often causing the prolapse to spontaneously reduce and become asymptomatic. (2) Pessary treatment is used for symptomatic prolapse in non-pregnant women or elderly women who are unfit for surgery, not in pregnancy. (3) Cervical amputation (Manchester operation) is a surgical procedure for prolapse in non-pregnant women - absolutely contraindicated in pregnancy. (4) Cerclage is for cervical incompetence (recurrent second-trimester miscarriages), not for uterine prolapse. Reassurance and close monitoring is the correct management for uterine prolapse complicating pregnancy.\"\n},\n{id:65,\nstem:\"During delivery of HIV infected women, which of the following are recommended?<br>1. Zidovudine (ZDV) is given at the onset of labour.<br>2. Elective caesarean delivery reduces the risk of vertical transmission.<br>3. Amniotomy and oxytocin augmentation should be done.<br>4. Antiretroviral therapy should be given to all neonates.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Prevention of mother-to-child transmission (PMTCT) of HIV during labour and delivery: Statement 1 TRUE: Intrapartum ZDV (zidovudine) IV infusion at onset of labour reduces vertical transmission by reducing maternal viral load. Statement 2 TRUE: Elective (pre-labour) caesarean section at 38 weeks significantly reduces vertical transmission risk (from approximately 25% to less than 1-2% when combined with HAART), especially when maternal viral load is detectable or unknown. Statement 3 FALSE: Amniotomy (artificial rupture of membranes) and oxytocin augmentation are generally AVOIDED in HIV-positive women as they increase the duration of membrane rupture and fetal exposure to infected blood\/secretions, increasing vertical transmission risk. Interventions that increase fetal exposure to maternal blood should be minimised. Statement 4 TRUE: All neonates born to HIV-positive mothers receive antiretroviral prophylaxis (nevirapine syrup and\/or ZDV) regardless of maternal ART status. Statements 1, 2, and 4 are correct.\"\n},\n{id:66,\nstem:\"Which of the following can be a complication in the baby due to post maturity of pregnancy?<br>1. Meconium aspiration<br>2. Hypoglycemia<br>3. Intra ventricular haemorrhage<br>4. Polycythemia<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Post-maturity (post-dates pregnancy greater than 42 weeks) complications in the neonate - post-maturity syndrome (Clifford syndrome): (1) Meconium aspiration syndrome (statement 1 correct) - uteroplacental insufficiency causes fetal hypoxia, leading to in-utero passage of meconium; aspiration causes severe respiratory compromise. (2) Hypoglycaemia (statement 2 correct) - depleted glycogen stores in the post-mature fetus due to placental insufficiency; the infant is thin with reduced subcutaneous fat and may have hypoglycaemia after birth. (3) Intraventricular haemorrhage (statement 3) - this is a complication of PREMATURITY (not post-maturity); the fragile germinal matrix of preterm infants is susceptible to IVH. Post-mature infants are term\/post-term and do not have this risk. (4) Polycythaemia (statement 4 correct) - chronic fetal hypoxia stimulates EPO production, leading to polycythaemia (haematocrit greater than 65%), which can cause hyperviscosity syndrome. Statements 1, 2, and 4 are correct.\"\n},\n{id:67,\nstem:\"Intrahepatic cholestasis of pregnancy presents with which of the following features?<br>1. Pruritus after 28 weeks gestation, especially in palms and soles<br>2. Serum bilirubin levels > 5 mg%<br>3. Raised levels of serum bile acids<br>4. Features subside within two weeks postpartum<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Intrahepatic Cholestasis of Pregnancy (ICP \/ obstetric cholestasis): Statement 1 TRUE: The hallmark is pruritus (intense itching without rash) typically beginning after 28 weeks, CHARACTERISTICALLY affecting the palms and soles (nocturnal, intense). Statement 2 FALSE: Jaundice with significant hyperbilirubinaemia (greater than 5 mg%) occurs in only a minority (approximately 10-15%) of ICP cases and when present is mild. Serum bilirubin may be mildly elevated (usually 1-5 mg%) or normal. The dominant abnormality is raised BILE ACIDS, not bilirubin. Statement 3 TRUE: Elevated serum bile acids (greater than 10 micromol\/L, diagnostic threshold; greater than 40 micromol\/L associated with adverse fetal outcomes including stillbirth) is the DEFINING biochemical abnormality of ICP. Statement 4 TRUE: All symptoms and biochemical abnormalities resolve completely within 2-4 weeks after delivery. This postpartum resolution is characteristic and supports the diagnosis. Statements 1, 3, and 4 are correct.\"\n},\n{id:68,\nstem:\"Which of the following are blood values of Iron Deficiency Anaemia?<br>1. Serum iron is less than 30 ugm\/100 mL<br>2. Total iron binding capacity is less than 400 ugm\/dL<br>3. Percentage saturation is 10% or less<br>4. Serum ferritin is below 30 ugm\/L<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Iron deficiency anaemia - laboratory values: (1) Serum iron less than 30 microgm\/100 mL (normal 60-160 microgm\/dL; in IDA, serum iron is LOW) - statement 1 correct. (2) TIBC (Total Iron Binding Capacity) - in IDA, TIBC is ELEVATED (greater than 400 microgm\/dL, often 350-500+), not less than 400. IDA causes depletion of iron stores, leading to upregulation of transferrin production (increased TIBC). Statement 2 is INCORRECT (TIBC is raised in IDA, not less than 400). (3) Transferrin saturation (serum iron\/TIBC x 100) of 10% or less (normal 20-50%; in IDA, saturation falls to less than 16%, often less than 10%) - statement 3 correct. (4) Serum ferritin below 30 microgm\/L (normal 30-300 microgm\/L in women; serum ferritin is the most sensitive and specific marker of iron stores; in IDA it is low, often less than 12-15 microgm\/L) - statement 4 correct. Statements 1, 3, and 4 are correct.\"\n},\n{id:69,\nstem:\"Clinical features of an infant with Fetal growth retardation at birth include which of the following?<br>1. Physical features give an old man look.<br>2. Baby is alert, reflexes are normal.<br>3. There is presence of weight deficit.<br>4. Thick fat accumulates around shoulders of baby.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Fetal growth restriction (FGR\/IUGR) - clinical features at birth (Clifford syndrome features in post-mature IUGR): Statement 1 TRUE: The classic description is an old-man appearance (wizened, wrinkled face, loose skin folds from loss of subcutaneous fat, prominent eyes), meconium-stained skin, peeling skin. Statement 2 TRUE: Despite the poor nutritional state, the FGR infant is typically ALERT with normal or hyperactive reflexes (in contrast to the lethargic, hypotonic preterm infant). Alertness indicates intact neurological development. Statement 3 TRUE: Weight deficit (weight below the 10th centile for gestational age) is the defining feature of FGR\/SGA. Statement 4 FALSE: FGR infants have markedly REDUCED subcutaneous fat (including around the shoulders and trunk) - that is why they look thin and wizened. It is the healthy term infant (or macrosomic infant of diabetic mother) that has fat deposition around the shoulders. Statements 1, 2, and 3 are correct.\"\n},\n{id:70,\nstem:\"Which of the following are correct regarding Chhaya contraceptive?<br>1. It has potent anti-estrogenic and weak estrogenic property.<br>2. Failure rate is 1-4 per HWY (Hundred Women Years) of use.<br>3. It inhibits ovulation.<br>4. It creates asynchrony between zygote and endometrium.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Chhaya is the brand name for Centchroman (Ormeloxifene) - a non-hormonal, non-steroidal oral contraceptive (SERM - Selective Estrogen Receptor Modulator) developed in India by CDRI Lucknow. Mechanism of action: (1) Potent anti-estrogenic + weak estrogenic properties (statement 1 correct) - acts as an estrogen antagonist at uterine endometrium but has weak estrogenic effects at other sites (e.g., bone, lipids). (2) Failure rate 1-4 per HWY (statement 2 correct) - the quoted failure rate in clinical studies. (3) It does NOT inhibit ovulation (statement 3 INCORRECT) - unlike combined oral contraceptives, Centchroman does NOT suppress the HPO axis or inhibit ovulation; regular ovulatory cycles are maintained. (4) Creates asynchrony between zygote and endometrium (statement 4 correct) - Centchroman advances endometrial maturation out of synchrony with the fertilised egg, preventing implantation. Its primary mechanism is anti-implantation. Statements 1, 2, and 4 are correct.\"\n},\n{id:71,\nstem:\"Which of the following are examples of LARC (Long Acting Reversible Contraceptives)?<br>1. Copper-T 380A<br>2. Implants<br>3. LNG-IUS<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Long-Acting Reversible Contraceptives (LARCs) are highly effective contraceptive methods that are reversible and require no user action after insertion. They include: (1) Copper-T 380A (ParaGard) - intrauterine device (IUD) providing up to 10-12 years of protection; statement 1 correct. (2) Implants (e.g., Implanon\/Nexplanon - single rod etonogestrel implant; Jadelle - two-rod levonorgestrel implant) providing 3-5 years of protection; statement 2 correct. (3) LNG-IUS (Levonorgestrel-releasing intrauterine system, e.g., Mirena) - an IUD releasing levonorgestrel locally, effective for 5 years; statement 3 correct. Other LARCs include injectable contraceptives (DMPA - Depo-Provera, every 3 months). LARCs have failure rates less than 1% per year, superior to OCP compliance-dependent methods. All three statements are correct.\"\n},\n{id:72,\nstem:\"How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?\",\ncorrect:\"4\",\nopts:[\"3\",\"4\",\"5\",\"6\"],\nexp:\"Extended-cycle combined oral contraceptive (COC) regimens are designed to reduce the frequency of withdrawal bleeding (scheduled menstruation) below the traditional monthly (13 times\/year with standard 28-day cycling). Extended regimens include: 91-day (13-week) cycle: 84 days of active pills followed by 7 days of inactive pills, resulting in withdrawal bleeding 4 times per year. This is the most common extended regimen (e.g., Seasonale, Seasonique in the USA; 91-day COC packs). Some regimens use 63-day cycles (3 times per year) or continuous dosing (once per year). The question specifically asks about extended CONTINUOUS regimens where bleeding occurs 4 times per year - corresponding to the 91-day extended cycle (quarterly withdrawal bleeds). The correct answer is 4.\"\n},\n{id:73,\nstem:\"Bilateral total salpingectomy is recommended surgical procedure to reduce the risk of\",\ncorrect:\"Fallopian tube cancer\",\nopts:[\"Epithelial ovarian cancer\",\"Uterine cancer\",\"Fallopian tube cancer\",\"Peritoneal cancer\"],\nexp:\"Bilateral salpingectomy (surgical removal of both fallopian tubes) has been shown to significantly reduce the risk of high-grade serous OVARIAN cancer (and peritoneal cancer) as well as FALLOPIAN TUBE cancer, because it is now established that a significant proportion of so-called ovarian cancers and peritoneal cancers actually originate from the fimbriated end of the fallopian tube (particularly serous tubal intraepithelial carcinoma - STIC lesions). Bilateral salpingectomy at the time of hysterectomy or other gynaecological surgery (opportunistic salpingectomy) is now recommended by RCOG, ACOG, and SOGC as a cancer risk reduction strategy. Among the direct options, FALLOPIAN TUBE cancer is the most directly reduced by salpingectomy (100% risk reduction by removing the tubes). The risk of ovarian cancer and peritoneal cancer is also substantially reduced.\"\n},\n{id:74,\nstem:\"Tongue bite occurs in eclampsia at\",\ncorrect:\"Tonic stage\",\nopts:[\"Tonic stage\",\"Clonic stage\",\"Coma stage\",\"Postictal stage\"],\nexp:\"Eclamptic convulsions progress through four stages: (1) Premonitory stage (15-30 seconds): facial twitching, rolling of eyes. (2) TONIC stage (15-30 seconds): the entire body goes into rigid muscular spasm (opisthotonus); the jaws clench tightly - TONGUE BITE occurs during this stage as the jaws clamp shut on the tongue; breath-holding causes cyanosis. (3) Clonic stage (1-2 minutes): violent rhythmic jerking of all extremities; foaming at mouth (saliva + blood from tongue bite); further risk of aspiration. (4) Coma\/Resolution stage: varying depth of unconsciousness, may progress to deep coma (especially in severe eclampsia). Tongue bite is the pathognomonic injury of the TONIC stage when jaw muscles contract maximally and clamp shut on the tongue. This is an important clinical pearl in obstetric emergencies.\"\n},\n{id:75,\nstem:\"Indication for removal of IUDs include which of the following?<br>1. Perforation of uterus<br>2. Pregnancy with device in situ<br>3. One year after menopause<br>4. Persistent migraine<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Indications for removal of intrauterine device (IUD): (1) Perforation of uterus (statement 1 correct): if the IUD has perforated the uterine wall, it must be removed (usually laparoscopically) to prevent intestinal obstruction, adhesions, and other complications. (2) Pregnancy with device in situ (statement 2 correct): if the woman becomes pregnant with the IUD in place and the threads are visible, the IUD should be removed (reduces risk of septic abortion, second-trimester loss, preterm labour). If threads are not visible, leave in place. (3) One year after menopause (statement 3 correct): IUDs should be removed approximately 12 months after the last menstrual period (confirmed menopause), as there is no longer a contraceptive need and the atrophic uterus makes removal easier now than later. (4) Persistent migraine: this is a contraindication to HORMONAL contraceptives (specifically combined OCP), NOT to copper IUD or LNG-IUS removal. Statements 1, 2, and 3 are correct.\"\n},\n{id:76,\nstem:\"Which of the following are the absolute contraindications for the use of combined oral contraceptive pills?<br>1. Severe hypertension<br>2. Pregnancy<br>3. Diabetes with retinopathy<br>4. Gall bladder disease<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Absolute contraindications to Combined Oral Contraceptives (COC) per WHO MEC Category 4: (1) Severe hypertension (BP greater than 160\/100 mmHg) - COCs increase thrombotic risk and worsen hypertension; absolute contraindication per WHO MEC - statement 1 correct. (2) Pregnancy - COCs are contraindicated in pregnancy (though not teratogenic if taken inadvertently, there is no indication) - statement 2 correct. (3) Diabetes with retinopathy (or nephropathy\/neuropathy\/vascular disease) - vascular complications of diabetes combined with the thrombogenic and atherogenic effects of COC estrogen create unacceptable risk - statement 3 correct. (4) Gallbladder disease - COCs increase biliary cholesterol saturation and may worsen symptomatic gallstones, but this is a RELATIVE contraindication (WHO MEC Category 2-3), NOT an absolute contraindication. Statements 1, 2, and 3 are absolute contraindications.\"\n},\n{id:77,\nstem:\"A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her?\",\ncorrect:\"Nexplanon\",\nopts:[\"Combined oral contraceptives\",\"Diaphragm\",\"Nexplanon\",\"Chhaya\"],\nexp:\"A young recently married woman requesting LONG-TERM REVERSIBLE contraception requires a LARC (Long-Acting Reversible Contraceptive). Analysis of options: (a) Combined oral contraceptives - effective but require daily compliance, NOT long-term; failure rate 7-9% with typical use. (b) Diaphragm - barrier method requiring insertion before each intercourse, moderate efficacy (failure rate 12-17% typical use), NOT long-acting. (c) Nexplanon (etonogestrel implant) - a single rod subdermal implant providing highly effective (failure rate less than 0.1%) reversible contraception for 3 years. It is a true LARC meeting all criteria: long-acting, reversible, highly effective, no daily compliance required. (d) Chhaya (centchroman) - weekly oral pill; effective but requires weekly compliance, not truly long-acting. Nexplanon is the best suited LARC option for a young woman requesting long-term reversible contraception.\"\n},\n{id:78,\nstem:\"Which one of the following is an indication for cold knife conisation?\",\ncorrect:\"Inconsistent findings of colposcopy, cytology and directed biopsy\",\nopts:[\"Treatment of Nabothian follicle on ectocervix\",\"Inconsistent findings of colposcopy, cytology and directed biopsy\",\"Negative endocervical curettage\",\"Squamous cell carcinoma cervix stage IIA\"],\nexp:\"Cold knife conisation (CKC) of the cervix is a diagnostic and therapeutic procedure for cervical intraepithelial neoplasia. Indications for CKC: (1) Discordance\/inconsistency between colposcopic findings, cervical cytology (Pap smear), and directed colposcopic biopsy - statement (b) correct. When the three modalities give conflicting results, CKC provides a larger specimen for complete histological assessment, including the transformation zone and endocervical canal. (2) Unsatisfactory colposcopy (squamocolumnar junction not visible). (3) Positive endocervical curettage (ECC) - NOT negative ECC; when ECC shows CIN or adenocarcinoma in situ, CKC is needed to assess the endocervical canal extent. (4) Nabothian follicles are benign retention cysts, not an indication for any treatment. (5) SCC cervix stage IIA requires radical hysterectomy\/radiotherapy, not conisation. Inconsistent colposcopy\/cytology\/biopsy findings is the correct indication.\"\n},\n{id:79,\nstem:\"Which of the following statements are correct regarding female sterilization?<br>1. It can be done 24-48 hours following delivery.<br>2. Ideal time for interval ligation is luteal phase preceding menstruation.<br>3. It can be combined with medical termination of pregnancy.<br>4. It is a preventive measure against serous ovarian cancer.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Female sterilisation (tubal ligation): Statement 1 TRUE: Postpartum sterilisation can be performed within 24-48 hours of delivery (minilaparotomy with Pomeroy technique), when the uterus is still enlarged making the tubes easily accessible; this is the ideal time for postpartum sterilisation. Statement 2 TRUE: Interval (non-puerperal) tubal ligation is ideally performed in the LUTEAL PHASE (post-ovulatory, days 15-26) when the woman is definitely not pregnant (ovulation has already occurred) and before the next menstrual period; this prevents inadvertent sterilisation during an undetected early pregnancy. Statement 3 TRUE: Sterilisation can be combined with MTP (medical termination of pregnancy) - this is called concurrent\/simultaneous sterilisation and MTP. Statement 4 FALSE: Tubal LIGATION alone does not significantly reduce ovarian cancer risk; it is bilateral SALPINGECTOMY that reduces the risk of serous ovarian cancer. Some studies show modest risk reduction with ligation but it is not the standard recommendation. Statements 1, 2, and 3 are correct.\"\n},\n{id:80,\nstem:\"The most popular technique of tubal ligation is\",\ncorrect:\"Pomeroy Technique\",\nopts:[\"Madlener Operation\",\"Pomeroy Technique\",\"Uchida method\",\"Cornual resection\"],\nexp:\"Pomeroy technique is the most widely used and popular method of tubal ligation worldwide. Procedure: a loop of the mid-portion of the fallopian tube is ligated with a plain catgut suture (absorbable), and the loop above the ligature is excised. As the catgut absorbs, the two ends of the tube separate and the cut ends seal over, creating a gap and permanent blockage. Advantages: simple, quick, effective, low failure rate (approximately 0.4%), easily reversible (anastomosis possible if small segments removed). Madlener operation: the tube is crushed and ligated without excision - higher failure rate, largely abandoned. Uchida method: ampullary portion injected with saline-adrenaline, then excised - technically complex. Cornual resection: removing the cornual portion - risk of scar ectopic pregnancy. 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Submitting in 10 Submit Now Combined Medical Services Examination 2023Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part B Obstetrics · Gynaecology · Family Planning · Reproductive Medicine Questions 41–80 Options… <\/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-36746","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2023 P2 Part-B OBG - 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\/05\/03\/cms-2023-p2-part-b-obg\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2023 P2 Part-B OBG - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2023 | General Medicine & Paediatrics | Paper I | Part A ✓️ 0 ❌ 0 ⏳ 40 left ⏱ 40:00 Net 0 \/ 160 Time's Up! 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40, MAX = 160;\nvar TSECS = 2400, GSECS = 10;\nvar LTRS = [\"A\",\"B\",\"C\",\"D\"];\n\nvar QQ = [\n{id:41,\nstem:\"The daily requirement of iron during second half of pregnancy is\",\ncorrect:\"20 mg per day\",\nopts:[\"2 mg per day\",\"6 mg per day\",\"10 mg per day\",\"20 mg per day\"],\nexp:\"Iron requirements increase dramatically during pregnancy due to: expansion of maternal red cell mass (approximately 450 mg), fetal iron requirement (approximately 300 mg), placental iron (approximately 50 mg), and delivery losses. Daily requirements: non-pregnant woman: 2 mg\/day; first trimester: 2-4 mg\/day; second half of pregnancy (second and third trimester): 6-8 mg elemental iron per day absorbed, but the dietary requirement accounting for absorption efficiency is approximately 20 mg per day (since only about 20-30% of dietary iron is absorbed). The Government of India and WHO recommend supplementation with 100-200 mg elemental iron daily in the second half of pregnancy. Among the options, 20 mg per day reflects the absorbed\/supplemental requirement standard in Indian obstetric examinations.\"\n},\n{id:42,\nstem:\"Carbohydrate metabolism in normal pregnancy shows\",\ncorrect:\"Fasting hypoglycaemia\",\nopts:[\"Fasting hypoglycaemia\",\"Postprandial hypoglycaemia\",\"Increased sensitivity of insulin receptors in mother\",\"Decreased plasma glucagon levels\"],\nexp:\"Normal pregnancy is characterised by diabetogenic changes to ensure adequate glucose supply for the fetus. Key metabolic changes: (1) Fasting hypoglycaemia (correct answer) - due to continuous placental glucose transfer to the fetus, maternal fasting glucose levels are lower than in non-pregnant state (accelerated starvation); (2) Postprandial hyperglycaemia (NOT hypoglycaemia) - diabetogenic hormones (hPL, progesterone, cortisol, glucagon) cause insulin resistance, leading to higher post-meal glucose levels; (3) DECREASED insulin sensitivity\/insulin resistance (not increased sensitivity) - due to anti-insulin hormones (hPL is the main one); (4) Increased plasma glucagon levels. The hallmark is: fasting hypoglycaemia + postprandial hyperglycaemia, creating the diabetogenic state of pregnancy.\"\n},\n{id:43,\nstem:\"A typical case of Iron Deficiency Anaemia (IDA) in pregnancy will show which of the following?<br>1. Hb less than 10gm%<br>2. PCV less than 30%<br>3. MCHC more than 30%<br>4. Microcytic hypochromic picture on peripheral blood smear (PBS)<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Iron deficiency anaemia (IDA) in pregnancy - laboratory findings: (1) Hb less than 10 g% (WHO defines anaemia in pregnancy as Hb less than 11 g\/dL; severe anaemia in India is Hb less than 7 g\/dL; Hb less than 10 g% is a commonly used threshold for IDA in Indian obstetric examinations) - statement 1 correct. (2) PCV (haematocrit) less than 30% (normal in pregnancy is approximately 33-38%; below 30% indicates significant anaemia) - statement 2 correct. (3) MCHC MORE than 30%: this statement is incorrect. In IDA, MCHC is LOW (less than 30-32 g\/dL) because the red cells are poorly haemoglobinised (hypochromic). MCHC above 30% would be normal or seen in spherocytosis, NOT IDA. (4) Microcytic hypochromic picture on PBS - classic morphology of IDA - statement 4 correct. Statements 1, 2, and 4 are correct.\"\n},\n{id:44,\nstem:\"Which of the following are the clinical features of molar pregnancy?<br>1. History of amenorrhoea and vaginal bleeding<br>2. Patient has excessive vomiting<br>3. History of expulsion of grape-like vesicles<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Hydatidiform mole (molar pregnancy) is a gestational trophoblastic disease with characteristic clinical features: (1) Amenorrhoea followed by vaginal bleeding (statement 1) - brownish PV bleeding (prune juice appearance) in the first trimester is the most common presenting symptom; (2) Hyperemesis (excessive vomiting, statement 2) - due to markedly elevated beta-hCG levels stimulating hypothalamic vomiting centres; occurs more severely than in normal pregnancy; (3) Expulsion of grape-like vesicles (statement 3) - pathognomonic of molar pregnancy; the characteristic grape-like translucent vesicles (hydropic villi) may be expelled per vaginum. Other features: uterus larger than dates, absent fetal heart sounds, snowstorm pattern on ultrasound, markedly elevated beta-hCG. All three statements are correct.\"\n},\n{id:45,\nstem:\"Which of the following vaccines can be given to a pregnant woman?<br>1. COVID vaccine<br>2. Measles, Mumps, Rubella vaccine<br>3. Hepatitis B vaccine<br>4. Rabies vaccine<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Vaccines in pregnancy - safe vs contraindicated: SAFE in pregnancy (inactivated\/killed vaccines, toxoids, subunit vaccines): TT\/Td (tetanus, mandatory in antenatal care), Hepatitis B (statement 3 correct), Influenza (inactivated), COVID-19 vaccines (mRNA and adenoviral vector vaccines are recommended for pregnant women per WHO\/CDC\/IAP, statement 1 correct), Rabies (post-exposure prophylaxis can be given in pregnancy, statement 4 correct), Pneumococcal, Meningococcal. CONTRAINDICATED in pregnancy (live attenuated vaccines): MMR (Measles, Mumps, Rubella) - statement 2 INCORRECT - live attenuated viral vaccine with theoretical teratogenic risk; women should avoid pregnancy for 1 month after MMR vaccination. Varicella, Yellow fever (avoid unless high risk), BCG, Oral typhoid (Ty21a), OPV. Statements 1, 3, and 4 are correct.\"\n},\n{id:46,\nstem:\"Which of the following are the characteristics of true labour pains?<br>1. Intensity and duration of contractions increase progressively<br>2. Progressive effacement and dilatation of the cervix<br>3. Formation of the bag of forewaters<br>4. Pain is confined to lower abdomen and groin<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"True labour pains vs false labour (Braxton Hicks) contractions: True labour pain characteristics: (1) Contractions increase progressively in intensity, duration (from 20-30 sec to 60-90 sec), and frequency (from 15-20 min apart to 2-3 min apart) - statement 1 correct. (2) Progressive effacement (thinning) and dilatation of the cervix - this is the DEFINING feature of true labour; Braxton Hicks do not cause cervical change - statement 2 correct. (3) Formation of the bag of forewaters (forewater bag\/forebag) - the lower pole of the membranes bulges into the cervical os as it dilates - statement 3 correct. (4) In TRUE labour, pain typically starts in the BACK and radiates to the lower abdomen and groin (NOT confined to lower abdomen); pain confined only to lower abdomen without back component may be false labour. Statement 4 is not the characteristic of true labour. Statements 1, 2, and 3 are correct.\"\n},\n{id:47,\nstem:\"Which are the parts of active management of third stage of labour?<br>1. Injection oxytocin 10 units IM within 1 minute of delivery of baby<br>2. Injection oxytocin 10 units IM at the birth of first twin in twin pregnancy<br>3. Controlled cord traction<br>4. Delayed cord clamping as per indications<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Active Management of Third Stage of Labour (AMTSL) - current WHO\/FIGO components: (1) Uterotonic administration: Oxytocin 10 IU IM (or IV) within 1 minute of delivery of the baby (statement 1 correct) - this is the MOST IMPORTANT component. (2) In twin pregnancy, oxytocin should be given after delivery of the LAST twin (not the first twin) - statement 2 is INCORRECT; giving oxytocin after the first twin would contract the uterus and compromise the second twin. (3) Controlled cord traction (CCT\/Brandt-Andrews method) - statement 3 correct - gentle traction on the cord while applying suprapubic counter-pressure to deliver the placenta. (4) Delayed cord clamping is NOW recommended as part of neonatal care (beneficial for the neonate) but is NOT traditionally listed as part of AMTSL for preventing PPH. Statements 1 and 3 are the core AMTSL components; among the options, 1, 2, and 3 is the closest answer per this examination.\"\n},\n{id:48,\nstem:\"Which of the following are correct regarding acute mastitis?<br>1. It usually occurs in first 2-4 weeks postpartum.<br>2. Microscopic examination of breast milk shows leukocyte count more than 10^6\/mL and bacterial count more than 10^3\/mL.<br>3. Common organisms are bacteroids, E. coli and Klebsiella.<br>4. The source of infection is infant's nose and throat.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Lactation mastitis (puerperal mastitis): Statement 1 TRUE: Acute puerperal mastitis most commonly occurs in the first 2-6 weeks postpartum (peak 2-4 weeks), affecting approximately 10% of breastfeeding women. Statement 2 TRUE: WHO diagnostic criteria for mastitis include: leukocytes greater than 10^6\/mL and bacterial count greater than 10^3\/mL in breast milk. Statement 3 FALSE: The most common causative organism is Staphylococcus aureus (responsible for approximately 80-90% of cases, including MRSA), NOT Bacteroides, E. coli, or Klebsiella. These gram-negative organisms cause mastitis in non-puerperal or neonatal mastitis. Statement 4 TRUE: The primary source of S. aureus infection is the infant's nose, throat, and skin; the infant colonises the nipple via suckling, and bacteria enter through cracks\/fissures. Statements 1, 2, and 4 are correct.\"\n},\n{id:49,\nstem:\"As per the classification of Obstetric Anal Sphincter Injury (RCOG-2007), tear of greater than 50% of External Anal Sphincter is of degree\",\ncorrect:\"3b\",\nopts:[\"3c\",\"2c\",\"3b\",\"3a\"],\nexp:\"RCOG (2007) classification of obstetric anal sphincter injuries (OASI): First degree: injury to perineal skin only. Second degree: injury involving perineal muscles but not the anal sphincter. Third degree: injury to the perineum involving the anal sphincter complex - subdivided as: 3a: Less than 50% thickness of external anal sphincter (EAS) torn; 3b: MORE than 50% thickness of EAS torn; 3c: Both EAS and internal anal sphincter (IAS) torn. Fourth degree: injury involving the anal sphincter complex AND anal epithelium\/rectal mucosa. A tear involving greater than 50% of the EAS is classified as 3b. This classification is important as it guides surgical repair and prognosis; 3b and 3c injuries require meticulous overlapping sphincter repair by a trained surgeon.\"\n},\n{id:50,\nstem:\"What are the causes of lactation failure after delivery?<br>1. Infrequent suckling<br>2. Depression or anxiety state in the puerperium<br>3. Prolactin inhibition<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Lactation failure (insufficient milk production) after delivery - causes: (1) Infrequent suckling (statement 1): Prolactin release is a neuroendocrine reflex triggered by nipple suckling. Infrequent or inadequate suckling reduces prolactin pulses and milk production. Demand-supply: more suckling = more milk. (2) Depression or anxiety in the puerperium (statement 2): Psychological stress, postnatal depression, and anxiety inhibit oxytocin release (milk let-down reflex), reducing effective milk transfer and leading to engorgement and eventual lactation failure. (3) Prolactin inhibition (statement 3): Any cause of hypoprolactinaemia (e.g., Sheehan syndrome\/pituitary necrosis after PPH, dopamine agonists like bromocriptine, cabergoline) causes lactation failure by removing the hormonal drive for milk synthesis. All three statements are correct causes of lactation failure.\"\n},\n{id:51,\nstem:\"Secondary arrest of dilatation during the process of labour may be due to which of the following factors?<br>1. Poor uterine contractions<br>2. Cessation of cervical dilatation despite strong uterine contractions<br>3. Disproportion and malpresentation<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Secondary arrest of dilatation (secondary arrest of cervical dilatation) occurs after the active phase of labour has been established (usually after 4 cm dilatation) and dilatation then stops for 2 or more hours. Causes: (1) Poor uterine contractions\/uterine inertia (hypotonic uterine dysfunction) - the most common cause; inadequate power is the first thing to correct (statement 1 correct). (2) Cessation of cervical dilatation despite strong contractions (statement 2) suggests an abnormality of the passenger or passage, not power - this is how secondary arrest may present clinically. (3) Disproportion (cephalopelvic disproportion, CPD) and malpresentation (e.g., brow presentation, deep transverse arrest) - obstruction to the descent and rotation of the presenting part causes arrest despite adequate uterine contractions (statement 3 correct). All three are causes of secondary arrest of dilatation.\"\n},\n{id:52,\nstem:\"First stage of labour starts from\",\ncorrect:\"the onset of true labour pains and ends with the full dilatation of cervix\",\nopts:[\"full dilatation of cervix to the expulsion of the fetus from the birth canal\",\"maternal bearing down efforts and ends with the delivery of the baby\",\"the onset of true labour pains and ends with the full dilatation of cervix\",\"the formation of bag of waters\"],\nexp:\"The three stages of labour: FIRST STAGE: From the onset of true labour pains (regular, progressive uterine contractions causing cervical effacement and dilatation) to full dilatation of the cervix (10 cm). It has two phases: latent phase (0-4 cm, slow dilatation) and active phase (4-10 cm, rapid dilatation approximately 1 cm\/hour in primigravida, 1.5 cm\/hour in multigravida). SECOND STAGE: From full dilatation of the cervix to the delivery\/expulsion of the baby. It includes the descent, rotation, and delivery of the fetal head and body. THIRD STAGE: From delivery of the baby to expulsion of the placenta and membranes. Option (c) correctly defines the first stage of labour.\"\n},\n{id:53,\nstem:\"Vesicovaginal fistula is classified as complicated if it has which of the following features?<br>1. Size - more than 3 cm<br>2. Bladder involvement - Supratrigonal<br>3. Location - Midvaginal<br>4. Presence of prior radiation<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Classification of vesicovaginal fistula (VVF) as complicated (associated with poorer surgical outcomes and requiring specialist management): Features of COMPLICATED VVF: (1) Large size (greater than 3 cm) - statement 1 correct; larger fistulae are more difficult to repair and have higher failure rates. (2) Supratrigonal location (involving the bladder trigone, ureterovaginal involvement, or near the ureteral orifices) - statement 2 correct; trigonal involvement risks ureteral injury during repair. (3) Midvaginal location alone is NOT a complicating feature; it is the juxtacervical or trigonal location that matters - statement 3 is NOT a complicating criterion. (4) Prior radiation (radiation-induced VVF) - statement 4 correct; irradiated tissues are poorly vascularised, avascular, and heal poorly, making repair extremely challenging. Statements 1, 2, and 4 are features of complicated VVF.\"\n},\n{id:54,\nstem:\"Which of the following set of muscles collectively form the muscle Levator Ani that forms the pelvic floor?<br>1. Ischiococcygeus<br>2. Pubococcygeus<br>3. Sacrococcygeus<br>4. Iliococcygeus<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"The levator ani is the principal muscle of the pelvic floor. It is a broad, thin muscle formed by the fusion of three muscle components: (1) Pubococcygeus (statement 2 correct) - arises from the posterior surface of the pubic body, passes posteriorly to insert into the anococcygeal raphe and coccyx; includes the puborectalis and pubovaginalis subdivisions. (2) Iliococcygeus (statement 4 correct) - arises from the arcus tendineus levator ani (thickened obturator fascia) and the ischial spine, inserts into the anococcygeal raphe and coccyx. (3) Ischiococcygeus\/Coccygeus (statement 1 correct) - technically the coccygeus is sometimes considered a separate muscle from the levator ani, but in clinical\/examination contexts it is often included as a component of the pelvic diaphragm. Sacrococcygeus (statement 3) is NOT a component of the levator ani; it is a vestigial muscle of the dorsal surface of the sacrum. Statements 1, 2, and 4 are correct.\"\n},\n{id:55,\nstem:\"Blood supply to the uterus comes from which of the following arteries?<br>1. Ovarian artery<br>2. Vaginal artery<br>3. Uterine artery<br>4. Inferior vesical artery<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Blood supply to the uterus: Primary supply: (1) Uterine artery (statement 3 correct) - a branch of the anterior division of the internal iliac artery; it is the MAIN blood supply to the uterus, ascending along the lateral wall and giving branches to the uterine body, cervix, and upper vagina. (2) Ovarian artery (statement 1 correct) - a branch of the abdominal aorta; it anastomoses with the uterine artery at the uterine cornu to supply the fundus and fallopian tube. (3) Vaginal artery (statement 2 correct) - a branch of the internal iliac artery; supplies the cervix and upper vagina, anastomosing with the uterine artery. Inferior vesical artery (statement 4) supplies the bladder and lower ureter, NOT the uterus. The azygos arteries of the vagina arise from the uterine and vaginal arteries, not the inferior vesical. Statements 1, 2, and 3 are correct.\"\n},\n{id:56,\nstem:\"Which one of the following is a prerequisite for Endometrial Ablation?\",\ncorrect:\"Woman who prefers to preserve her uterus\",\nopts:[\"Uterus is 12-14 weeks size\",\"Woman wants to preserve her reproductive function\",\"Fibroids > 3 cm in size\",\"Woman who prefers to preserve her uterus\"],\nexp:\"Endometrial ablation is a minimally invasive procedure that destroys the endometrium to reduce or eliminate heavy menstrual bleeding (menorrhagia). The procedure is indicated for women who: have completed their family (do not desire future fertility - this is a PREREQUISITE, not to preserve reproductive function), prefer uterus preservation to avoid hysterectomy, and have failed medical management. Prerequisites\/indications: (a) Uterus 12-14 weeks size is a contraindication (too large for the procedure). (b) Desire to preserve REPRODUCTIVE function is an ABSOLUTE CONTRAINDICATION (ablation destroys the endometrium, making successful implantation extremely unlikely and causing serious complications in any subsequent pregnancy). (c) Fibroids greater than 3 cm are a relative contraindication as they distort the cavity. (d) Woman who prefers to PRESERVE HER UTERUS (but not her fertility) - this is the correct prerequisite\/indication for ablation as an alternative to hysterectomy.\"\n},\n{id:57,\nstem:\"Which of the following day of menstrual cycle is best for endometrial sampling to diagnose ovulation?\",\ncorrect:\"21st - 23rd day\",\nopts:[\"8th - 10th day\",\"12th - 14th day\",\"16th - 20th day\",\"21st - 23rd day\"],\nexp:\"Endometrial biopsy for diagnosing ovulation (and assessing luteal phase adequacy) should be timed to the mid-luteal phase, approximately 7-10 days after expected ovulation. In a standard 28-day menstrual cycle: Ovulation occurs on day 14. Luteal phase: days 15-28. Mid-luteal phase (peak progesterone effect on endometrium): days 21-23. Endometrial sampling on days 21-23 shows secretory changes (dating of the endometrium by Noyes criteria), with glandular secretions, stromal oedema, and sub-nuclear vacuoles progressing to supra-nuclear secretions. A secretory endometrium on days 21-23 confirms ovulation has occurred. Earlier biopsies (days 8-14) show proliferative endometrium regardless of ovulation. Days 16-20 may show early secretory changes. Days 21-23 is optimal for confirming ovulation.\"\n},\n{id:58,\nstem:\"A 27-year-old female married for 3 years regularly cohabiting with husband presents to Gynaecology OPD with complaints of inability to conceive for 2 years. During clinical evaluation hysterosalpingography was done which revealed irregular outline of uterine cavity and rigid fallopian tubes with nodulations. Most likely cause for this condition is\",\ncorrect:\"Genital Tuberculosis\",\nopts:[\"Genital Herpes\",\"Syphilis\",\"Genital Tuberculosis\",\"Gonorrhoea\"],\nexp:\"The hysterosalpingography (HSG) findings described are pathognomonic of genital tuberculosis (TB): (1) Irregular outline of the uterine cavity - endometrial TB causes irregular filling defects, synechiae (Asherman-like pattern), and the classic triangular or calcified uterine cavity; (2) Rigid fallopian tubes with nodulations - salpingitis isthmica nodosa pattern; stiff, straight (pipe-stem) tubes without peristalsis; beaded or nodular appearance due to caseous deposits; (3) The combination of tubal rigidity (lack of normal tortuous appearance) with uterine cavity irregularity in a sub-fertile woman in the Indian subcontinent strongly points to genital TB. Genital TB is the most important cause of tubal infertility in developing countries. Treatment: standard ATT regimen. Gonorrhoea can cause tubal damage but the nodular rigid pattern with uterine cavity irregularity is characteristic of TB.\"\n},\n{id:59,\nstem:\"NACO (National AIDS Control Organization) in India works towards which of the following causes?<br>1. Screening high risk cases of HIV<br>2. Facilitating adoption of orphans<br>3. Public education towards safe sex<br>4. Treating HIV cases free of cost<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"NACO (National AIDS Control Organisation) was established in 1992 under the Ministry of Health and Family Welfare, Government of India. NACO's mandate and activities include: (1) Screening high risk groups for HIV (Integrated Counselling and Testing Centres, ICTC; targeted interventions for bridge populations) - statement 1 correct. (2) Facilitating adoption of orphans is NOT part of NACO's mandate; adoption is handled by CARA (Central Adoption Resource Authority) under the Ministry of Women and Child Development - statement 2 incorrect. (3) Public education and awareness campaigns for safe sex (IEC - Information, Education, Communication activities; condom promotion; behaviour change communication) - statement 3 correct. (4) Providing free ART (antiretroviral therapy) treatment through ART centres across India under the National AIDS Control Programme - statement 4 correct. Statements 1, 3, and 4 are correct.\"\n},\n{id:60,\nstem:\"Prophylactic oophorectomy is recommended in high risk women with which of the following?<br>1. Carrying BRCA1 or BRCA2 genes<br>2. Family history of breast, colon, ovarian cancer<br>3. Patients having tubo-ovarian abscess<br>Select the correct answer using the code given below.\",\ncorrect:\"1 and 2 only\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Risk-reducing bilateral salpingo-oophorectomy (RRBSO) is recommended in high-risk women: (1) BRCA1\/BRCA2 mutation carriers (statement 1 correct): BRCA1 carriers have 40-46% lifetime risk of ovarian cancer; BRCA2 carriers have 10-27% risk. RRBSO reduces ovarian cancer risk by 80-96% and breast cancer risk by approximately 50% when done before menopause. Recommended typically between age 35-40 for BRCA1 and 40-45 for BRCA2. (2) Strong family history of breast, colon (Lynch syndrome\/HNPCC), or ovarian cancer (statement 2 correct) - Lynch syndrome carries 10-12% lifetime risk of ovarian cancer; prophylactic surgery is recommended. (3) Tubo-ovarian abscess (TOA) - this is an acute infection requiring antibiotics and drainage; it is NOT an indication for prophylactic oophorectomy (it is treated medically or with surgical drainage, not prophylactic removal). Statements 1 and 2 are correct.\"\n},\n{id:61,\nstem:\"Schiller-Duval body is a characteristic histological feature of which one of the following cancers?\",\ncorrect:\"Endodermal sinus tumour\",\nopts:[\"Dysgerminoma\",\"Endodermal sinus tumour\",\"Non-gestational ovarian choriocarcinoma\",\"Sex cord stromal tumours\"],\nexp:\"Schiller-Duval bodies (also called glomeruloid bodies) are a pathognomonic histological feature of ENDODERMAL SINUS TUMOUR (EST, also known as yolk sac tumour) of the ovary. They are perivascular structures resembling primitive glomeruli: a central capillary surrounded by tumour cells, enclosed within a space lined by tumour cells - resembling the Duval-Schiller glomerulus of the rodent yolk sac. EST is a highly malignant ovarian germ cell tumour occurring in young women and girls (median age 18 years), secreting alpha-fetoprotein (AFP) - used as a tumour marker for diagnosis and monitoring. Treatment: BEP chemotherapy (bleomycin, etoposide, cisplatin). Schiller-Duval bodies are NOT seen in dysgerminoma (large cells with fibrous septa and lymphocytic infiltration), choriocarcinoma, or sex cord stromal tumours.\"\n},\n{id:62,\nstem:\"Which one of the following is the distinguishing feature to differentiate Gartner's cyst from Cystocele?\",\ncorrect:\"Gartner's cyst is not reducible\",\nopts:[\"Marked cough impulse in Gartner's cyst\",\"Margins are ill-defined in Gartner's cyst\",\"There is no impulse on coughing in cystocele\",\"Gartner's cyst is not reducible\"],\nexp:\"Gartner's cyst vs Cystocele differentiation: Gartner's duct cyst is a remnant of the mesonephric (Wolffian) duct, appearing as a cystic swelling in the antero-lateral wall of the vagina. Key distinguishing feature: Gartner's cyst is NOT REDUCIBLE (it is a true cyst with its own wall, fixed in the vaginal wall - does not reduce with pressure or change in position). Cystocele is a herniation of the bladder through the anterior vaginal wall. Cystocele IS reducible (the bladder can be pushed back into the pelvis with digital pressure). Both may show a cough impulse (the cystocele shows a marked cough impulse as the bladder is pushed forward; Gartner's cyst may also transmit some cough impulse but it is the non-reducibility that is the KEY distinguishing feature). Option (d) Gartner's cyst is not reducible is the correct distinguishing feature.\"\n},\n{id:63,\nstem:\"Surgical treatment by ventrosuspension of uterus is used for what condition?\",\ncorrect:\"Retroversion of uterus\",\nopts:[\"Pelvic organ prolapse\",\"Retroversion of uterus\",\"Rupture of uterus\",\"Vault prolapse\"],\nexp:\"Ventrosuspension (ventrofixation) of the uterus is a surgical procedure in which the round ligaments are shortened and\/or the uterus is sutured to the anterior abdominal wall to correct symptomatic retroversion of the uterus. Retroversion of the uterus (posterior tilt of the uterine body) may cause dysmenorrhoea, dyspareunia, backache, and pelvic pain in symptomatic cases. The procedure artificially maintains the uterus in an anteverted position. Note: ventrosuspension is now rarely performed as most retroversions are asymptomatic and mobile, and the procedure does not treat the underlying cause. Manchester repair and other procedures are used for prolapse. Surgical repair is used for uterine rupture. Sacrocolpopexy is used for vault prolapse. Ventrosuspension specifically treats retroversion of the uterus.\"\n},\n{id:64,\nstem:\"A 29-year-old female with 3 months amenorrhoea presents to gynaecology OPD with complaints of something coming out of her vagina. On clinical evaluation she was found to have single live pregnancy with second degree uterine prolapse. Which one of the following is the best management plan for her?\",\ncorrect:\"Reassurance\",\nopts:[\"Reassurance\",\"Cervical amputation\",\"Cerclage operation\",\"Pessary treatment\"],\nexp:\"Uterine prolapse complicating pregnancy is managed conservatively during pregnancy. In a young pregnant woman (29 years) with a desired single live pregnancy and second-degree uterine prolapse: (1) REASSURANCE is the appropriate management during pregnancy. As the pregnancy advances, the enlarging uterus naturally rises into the abdomen, often causing the prolapse to spontaneously reduce and become asymptomatic. (2) Pessary treatment is used for symptomatic prolapse in non-pregnant women or elderly women who are unfit for surgery, not in pregnancy. (3) Cervical amputation (Manchester operation) is a surgical procedure for prolapse in non-pregnant women - absolutely contraindicated in pregnancy. (4) Cerclage is for cervical incompetence (recurrent second-trimester miscarriages), not for uterine prolapse. Reassurance and close monitoring is the correct management for uterine prolapse complicating pregnancy.\"\n},\n{id:65,\nstem:\"During delivery of HIV infected women, which of the following are recommended?<br>1. Zidovudine (ZDV) is given at the onset of labour.<br>2. Elective caesarean delivery reduces the risk of vertical transmission.<br>3. Amniotomy and oxytocin augmentation should be done.<br>4. Antiretroviral therapy should be given to all neonates.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Prevention of mother-to-child transmission (PMTCT) of HIV during labour and delivery: Statement 1 TRUE: Intrapartum ZDV (zidovudine) IV infusion at onset of labour reduces vertical transmission by reducing maternal viral load. Statement 2 TRUE: Elective (pre-labour) caesarean section at 38 weeks significantly reduces vertical transmission risk (from approximately 25% to less than 1-2% when combined with HAART), especially when maternal viral load is detectable or unknown. Statement 3 FALSE: Amniotomy (artificial rupture of membranes) and oxytocin augmentation are generally AVOIDED in HIV-positive women as they increase the duration of membrane rupture and fetal exposure to infected blood\/secretions, increasing vertical transmission risk. Interventions that increase fetal exposure to maternal blood should be minimised. Statement 4 TRUE: All neonates born to HIV-positive mothers receive antiretroviral prophylaxis (nevirapine syrup and\/or ZDV) regardless of maternal ART status. Statements 1, 2, and 4 are correct.\"\n},\n{id:66,\nstem:\"Which of the following can be a complication in the baby due to post maturity of pregnancy?<br>1. Meconium aspiration<br>2. Hypoglycemia<br>3. Intra ventricular haemorrhage<br>4. Polycythemia<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Post-maturity (post-dates pregnancy greater than 42 weeks) complications in the neonate - post-maturity syndrome (Clifford syndrome): (1) Meconium aspiration syndrome (statement 1 correct) - uteroplacental insufficiency causes fetal hypoxia, leading to in-utero passage of meconium; aspiration causes severe respiratory compromise. (2) Hypoglycaemia (statement 2 correct) - depleted glycogen stores in the post-mature fetus due to placental insufficiency; the infant is thin with reduced subcutaneous fat and may have hypoglycaemia after birth. (3) Intraventricular haemorrhage (statement 3) - this is a complication of PREMATURITY (not post-maturity); the fragile germinal matrix of preterm infants is susceptible to IVH. Post-mature infants are term\/post-term and do not have this risk. (4) Polycythaemia (statement 4 correct) - chronic fetal hypoxia stimulates EPO production, leading to polycythaemia (haematocrit greater than 65%), which can cause hyperviscosity syndrome. Statements 1, 2, and 4 are correct.\"\n},\n{id:67,\nstem:\"Intrahepatic cholestasis of pregnancy presents with which of the following features?<br>1. Pruritus after 28 weeks gestation, especially in palms and soles<br>2. Serum bilirubin levels > 5 mg%<br>3. Raised levels of serum bile acids<br>4. Features subside within two weeks postpartum<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Intrahepatic Cholestasis of Pregnancy (ICP \/ obstetric cholestasis): Statement 1 TRUE: The hallmark is pruritus (intense itching without rash) typically beginning after 28 weeks, CHARACTERISTICALLY affecting the palms and soles (nocturnal, intense). Statement 2 FALSE: Jaundice with significant hyperbilirubinaemia (greater than 5 mg%) occurs in only a minority (approximately 10-15%) of ICP cases and when present is mild. Serum bilirubin may be mildly elevated (usually 1-5 mg%) or normal. The dominant abnormality is raised BILE ACIDS, not bilirubin. Statement 3 TRUE: Elevated serum bile acids (greater than 10 micromol\/L, diagnostic threshold; greater than 40 micromol\/L associated with adverse fetal outcomes including stillbirth) is the DEFINING biochemical abnormality of ICP. Statement 4 TRUE: All symptoms and biochemical abnormalities resolve completely within 2-4 weeks after delivery. This postpartum resolution is characteristic and supports the diagnosis. Statements 1, 3, and 4 are correct.\"\n},\n{id:68,\nstem:\"Which of the following are blood values of Iron Deficiency Anaemia?<br>1. Serum iron is less than 30 ugm\/100 mL<br>2. Total iron binding capacity is less than 400 ugm\/dL<br>3. Percentage saturation is 10% or less<br>4. Serum ferritin is below 30 ugm\/L<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 3 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Iron deficiency anaemia - laboratory values: (1) Serum iron less than 30 microgm\/100 mL (normal 60-160 microgm\/dL; in IDA, serum iron is LOW) - statement 1 correct. (2) TIBC (Total Iron Binding Capacity) - in IDA, TIBC is ELEVATED (greater than 400 microgm\/dL, often 350-500+), not less than 400. IDA causes depletion of iron stores, leading to upregulation of transferrin production (increased TIBC). Statement 2 is INCORRECT (TIBC is raised in IDA, not less than 400). (3) Transferrin saturation (serum iron\/TIBC x 100) of 10% or less (normal 20-50%; in IDA, saturation falls to less than 16%, often less than 10%) - statement 3 correct. (4) Serum ferritin below 30 microgm\/L (normal 30-300 microgm\/L in women; serum ferritin is the most sensitive and specific marker of iron stores; in IDA it is low, often less than 12-15 microgm\/L) - statement 4 correct. Statements 1, 3, and 4 are correct.\"\n},\n{id:69,\nstem:\"Clinical features of an infant with Fetal growth retardation at birth include which of the following?<br>1. Physical features give an old man look.<br>2. Baby is alert, reflexes are normal.<br>3. There is presence of weight deficit.<br>4. Thick fat accumulates around shoulders of baby.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Fetal growth restriction (FGR\/IUGR) - clinical features at birth (Clifford syndrome features in post-mature IUGR): Statement 1 TRUE: The classic description is an old-man appearance (wizened, wrinkled face, loose skin folds from loss of subcutaneous fat, prominent eyes), meconium-stained skin, peeling skin. Statement 2 TRUE: Despite the poor nutritional state, the FGR infant is typically ALERT with normal or hyperactive reflexes (in contrast to the lethargic, hypotonic preterm infant). Alertness indicates intact neurological development. Statement 3 TRUE: Weight deficit (weight below the 10th centile for gestational age) is the defining feature of FGR\/SGA. Statement 4 FALSE: FGR infants have markedly REDUCED subcutaneous fat (including around the shoulders and trunk) - that is why they look thin and wizened. It is the healthy term infant (or macrosomic infant of diabetic mother) that has fat deposition around the shoulders. Statements 1, 2, and 3 are correct.\"\n},\n{id:70,\nstem:\"Which of the following are correct regarding Chhaya contraceptive?<br>1. It has potent anti-estrogenic and weak estrogenic property.<br>2. Failure rate is 1-4 per HWY (Hundred Women Years) of use.<br>3. It inhibits ovulation.<br>4. It creates asynchrony between zygote and endometrium.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 4\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Chhaya is the brand name for Centchroman (Ormeloxifene) - a non-hormonal, non-steroidal oral contraceptive (SERM - Selective Estrogen Receptor Modulator) developed in India by CDRI Lucknow. Mechanism of action: (1) Potent anti-estrogenic + weak estrogenic properties (statement 1 correct) - acts as an estrogen antagonist at uterine endometrium but has weak estrogenic effects at other sites (e.g., bone, lipids). (2) Failure rate 1-4 per HWY (statement 2 correct) - the quoted failure rate in clinical studies. (3) It does NOT inhibit ovulation (statement 3 INCORRECT) - unlike combined oral contraceptives, Centchroman does NOT suppress the HPO axis or inhibit ovulation; regular ovulatory cycles are maintained. (4) Creates asynchrony between zygote and endometrium (statement 4 correct) - Centchroman advances endometrial maturation out of synchrony with the fertilised egg, preventing implantation. Its primary mechanism is anti-implantation. Statements 1, 2, and 4 are correct.\"\n},\n{id:71,\nstem:\"Which of the following are examples of LARC (Long Acting Reversible Contraceptives)?<br>1. Copper-T 380A<br>2. Implants<br>3. LNG-IUS<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1 and 2 only\",\"2 and 3 only\",\"1 and 3 only\",\"1, 2 and 3\"],\nexp:\"Long-Acting Reversible Contraceptives (LARCs) are highly effective contraceptive methods that are reversible and require no user action after insertion. They include: (1) Copper-T 380A (ParaGard) - intrauterine device (IUD) providing up to 10-12 years of protection; statement 1 correct. (2) Implants (e.g., Implanon\/Nexplanon - single rod etonogestrel implant; Jadelle - two-rod levonorgestrel implant) providing 3-5 years of protection; statement 2 correct. (3) LNG-IUS (Levonorgestrel-releasing intrauterine system, e.g., Mirena) - an IUD releasing levonorgestrel locally, effective for 5 years; statement 3 correct. Other LARCs include injectable contraceptives (DMPA - Depo-Provera, every 3 months). LARCs have failure rates less than 1% per year, superior to OCP compliance-dependent methods. All three statements are correct.\"\n},\n{id:72,\nstem:\"How many times in a year does withdrawal bleeding occur in extended continuous regimens of combined oral contraceptive pills?\",\ncorrect:\"4\",\nopts:[\"3\",\"4\",\"5\",\"6\"],\nexp:\"Extended-cycle combined oral contraceptive (COC) regimens are designed to reduce the frequency of withdrawal bleeding (scheduled menstruation) below the traditional monthly (13 times\/year with standard 28-day cycling). Extended regimens include: 91-day (13-week) cycle: 84 days of active pills followed by 7 days of inactive pills, resulting in withdrawal bleeding 4 times per year. This is the most common extended regimen (e.g., Seasonale, Seasonique in the USA; 91-day COC packs). Some regimens use 63-day cycles (3 times per year) or continuous dosing (once per year). The question specifically asks about extended CONTINUOUS regimens where bleeding occurs 4 times per year - corresponding to the 91-day extended cycle (quarterly withdrawal bleeds). The correct answer is 4.\"\n},\n{id:73,\nstem:\"Bilateral total salpingectomy is recommended surgical procedure to reduce the risk of\",\ncorrect:\"Fallopian tube cancer\",\nopts:[\"Epithelial ovarian cancer\",\"Uterine cancer\",\"Fallopian tube cancer\",\"Peritoneal cancer\"],\nexp:\"Bilateral salpingectomy (surgical removal of both fallopian tubes) has been shown to significantly reduce the risk of high-grade serous OVARIAN cancer (and peritoneal cancer) as well as FALLOPIAN TUBE cancer, because it is now established that a significant proportion of so-called ovarian cancers and peritoneal cancers actually originate from the fimbriated end of the fallopian tube (particularly serous tubal intraepithelial carcinoma - STIC lesions). Bilateral salpingectomy at the time of hysterectomy or other gynaecological surgery (opportunistic salpingectomy) is now recommended by RCOG, ACOG, and SOGC as a cancer risk reduction strategy. Among the direct options, FALLOPIAN TUBE cancer is the most directly reduced by salpingectomy (100% risk reduction by removing the tubes). The risk of ovarian cancer and peritoneal cancer is also substantially reduced.\"\n},\n{id:74,\nstem:\"Tongue bite occurs in eclampsia at\",\ncorrect:\"Tonic stage\",\nopts:[\"Tonic stage\",\"Clonic stage\",\"Coma stage\",\"Postictal stage\"],\nexp:\"Eclamptic convulsions progress through four stages: (1) Premonitory stage (15-30 seconds): facial twitching, rolling of eyes. (2) TONIC stage (15-30 seconds): the entire body goes into rigid muscular spasm (opisthotonus); the jaws clench tightly - TONGUE BITE occurs during this stage as the jaws clamp shut on the tongue; breath-holding causes cyanosis. (3) Clonic stage (1-2 minutes): violent rhythmic jerking of all extremities; foaming at mouth (saliva + blood from tongue bite); further risk of aspiration. (4) Coma\/Resolution stage: varying depth of unconsciousness, may progress to deep coma (especially in severe eclampsia). Tongue bite is the pathognomonic injury of the TONIC stage when jaw muscles contract maximally and clamp shut on the tongue. This is an important clinical pearl in obstetric emergencies.\"\n},\n{id:75,\nstem:\"Indication for removal of IUDs include which of the following?<br>1. Perforation of uterus<br>2. Pregnancy with device in situ<br>3. One year after menopause<br>4. Persistent migraine<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Indications for removal of intrauterine device (IUD): (1) Perforation of uterus (statement 1 correct): if the IUD has perforated the uterine wall, it must be removed (usually laparoscopically) to prevent intestinal obstruction, adhesions, and other complications. (2) Pregnancy with device in situ (statement 2 correct): if the woman becomes pregnant with the IUD in place and the threads are visible, the IUD should be removed (reduces risk of septic abortion, second-trimester loss, preterm labour). If threads are not visible, leave in place. (3) One year after menopause (statement 3 correct): IUDs should be removed approximately 12 months after the last menstrual period (confirmed menopause), as there is no longer a contraceptive need and the atrophic uterus makes removal easier now than later. (4) Persistent migraine: this is a contraindication to HORMONAL contraceptives (specifically combined OCP), NOT to copper IUD or LNG-IUS removal. Statements 1, 2, and 3 are correct.\"\n},\n{id:76,\nstem:\"Which of the following are the absolute contraindications for the use of combined oral contraceptive pills?<br>1. Severe hypertension<br>2. Pregnancy<br>3. Diabetes with retinopathy<br>4. Gall bladder disease<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Absolute contraindications to Combined Oral Contraceptives (COC) per WHO MEC Category 4: (1) Severe hypertension (BP greater than 160\/100 mmHg) - COCs increase thrombotic risk and worsen hypertension; absolute contraindication per WHO MEC - statement 1 correct. (2) Pregnancy - COCs are contraindicated in pregnancy (though not teratogenic if taken inadvertently, there is no indication) - statement 2 correct. (3) Diabetes with retinopathy (or nephropathy\/neuropathy\/vascular disease) - vascular complications of diabetes combined with the thrombogenic and atherogenic effects of COC estrogen create unacceptable risk - statement 3 correct. (4) Gallbladder disease - COCs increase biliary cholesterol saturation and may worsen symptomatic gallstones, but this is a RELATIVE contraindication (WHO MEC Category 2-3), NOT an absolute contraindication. Statements 1, 2, and 3 are absolute contraindications.\"\n},\n{id:77,\nstem:\"A 27-year-old recently married female comes to family planning clinic requesting for long term reversible contraception. Which one of the following is the best suited option for her?\",\ncorrect:\"Nexplanon\",\nopts:[\"Combined oral contraceptives\",\"Diaphragm\",\"Nexplanon\",\"Chhaya\"],\nexp:\"A young recently married woman requesting LONG-TERM REVERSIBLE contraception requires a LARC (Long-Acting Reversible Contraceptive). Analysis of options: (a) Combined oral contraceptives - effective but require daily compliance, NOT long-term; failure rate 7-9% with typical use. (b) Diaphragm - barrier method requiring insertion before each intercourse, moderate efficacy (failure rate 12-17% typical use), NOT long-acting. (c) Nexplanon (etonogestrel implant) - a single rod subdermal implant providing highly effective (failure rate less than 0.1%) reversible contraception for 3 years. It is a true LARC meeting all criteria: long-acting, reversible, highly effective, no daily compliance required. (d) Chhaya (centchroman) - weekly oral pill; effective but requires weekly compliance, not truly long-acting. Nexplanon is the best suited LARC option for a young woman requesting long-term reversible contraception.\"\n},\n{id:78,\nstem:\"Which one of the following is an indication for cold knife conisation?\",\ncorrect:\"Inconsistent findings of colposcopy, cytology and directed biopsy\",\nopts:[\"Treatment of Nabothian follicle on ectocervix\",\"Inconsistent findings of colposcopy, cytology and directed biopsy\",\"Negative endocervical curettage\",\"Squamous cell carcinoma cervix stage IIA\"],\nexp:\"Cold knife conisation (CKC) of the cervix is a diagnostic and therapeutic procedure for cervical intraepithelial neoplasia. Indications for CKC: (1) Discordance\/inconsistency between colposcopic findings, cervical cytology (Pap smear), and directed colposcopic biopsy - statement (b) correct. When the three modalities give conflicting results, CKC provides a larger specimen for complete histological assessment, including the transformation zone and endocervical canal. (2) Unsatisfactory colposcopy (squamocolumnar junction not visible). (3) Positive endocervical curettage (ECC) - NOT negative ECC; when ECC shows CIN or adenocarcinoma in situ, CKC is needed to assess the endocervical canal extent. (4) Nabothian follicles are benign retention cysts, not an indication for any treatment. (5) SCC cervix stage IIA requires radical hysterectomy\/radiotherapy, not conisation. Inconsistent colposcopy\/cytology\/biopsy findings is the correct indication.\"\n},\n{id:79,\nstem:\"Which of the following statements are correct regarding female sterilization?<br>1. It can be done 24-48 hours following delivery.<br>2. Ideal time for interval ligation is luteal phase preceding menstruation.<br>3. It can be combined with medical termination of pregnancy.<br>4. It is a preventive measure against serous ovarian cancer.<br>Select the correct answer using the code given below.\",\ncorrect:\"1, 2 and 3\",\nopts:[\"1, 2 and 3\",\"1, 2 and 4\",\"1, 3 and 4\",\"2, 3 and 4\"],\nexp:\"Female sterilisation (tubal ligation): Statement 1 TRUE: Postpartum sterilisation can be performed within 24-48 hours of delivery (minilaparotomy with Pomeroy technique), when the uterus is still enlarged making the tubes easily accessible; this is the ideal time for postpartum sterilisation. Statement 2 TRUE: Interval (non-puerperal) tubal ligation is ideally performed in the LUTEAL PHASE (post-ovulatory, days 15-26) when the woman is definitely not pregnant (ovulation has already occurred) and before the next menstrual period; this prevents inadvertent sterilisation during an undetected early pregnancy. Statement 3 TRUE: Sterilisation can be combined with MTP (medical termination of pregnancy) - this is called concurrent\/simultaneous sterilisation and MTP. Statement 4 FALSE: Tubal LIGATION alone does not significantly reduce ovarian cancer risk; it is bilateral SALPINGECTOMY that reduces the risk of serous ovarian cancer. Some studies show modest risk reduction with ligation but it is not the standard recommendation. Statements 1, 2, and 3 are correct.\"\n},\n{id:80,\nstem:\"The most popular technique of tubal ligation is\",\ncorrect:\"Pomeroy Technique\",\nopts:[\"Madlener Operation\",\"Pomeroy Technique\",\"Uchida method\",\"Cornual resection\"],\nexp:\"Pomeroy technique is the most widely used and popular method of tubal ligation worldwide. Procedure: a loop of the mid-portion of the fallopian tube is ligated with a plain catgut suture (absorbable), and the loop above the ligature is excised. As the catgut absorbs, the two ends of the tube separate and the cut ends seal over, creating a gap and permanent blockage. Advantages: simple, quick, effective, low failure rate (approximately 0.4%), easily reversible (anastomosis possible if small segments removed). Madlener operation: the tube is crushed and ligated without excision - higher failure rate, largely abandoned. Uchida method: ampullary portion injected with saline-adrenaline, then excised - technically complex. Cornual resection: removing the cornual portion - risk of scar ectopic pregnancy. 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Submitting in 10 Submit Now Combined Medical Services Examination 2023Surgery, Gynaecology & Obstetrics & Preventive Medicine · Paper II · Part B Obstetrics · Gynaecology · Family Planning · Reproductive Medicine Questions 41–80 Options… <\/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-36746","post","type-post","status-publish","format-standard","hentry","category-cms"],"yoast_head":"\n<title>CMS 2023 P2 Part-B OBG - 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\/05\/03\/cms-2023-p2-part-b-obg\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2023 P2 Part-B OBG - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2023 | General Medicine & Paediatrics | Paper I | Part A ✓️ 0 ❌ 0 ⏳ 40 left ⏱ 40:00 Net 0 \/ 160 Time's Up! 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