{"id":36777,"date":"2026-05-08T04:44:21","date_gmt":"2026-05-07T23:14:21","guid":{"rendered":"https:\/\/atsixty.com\/?p=36777"},"modified":"2026-05-08T04:47:46","modified_gmt":"2026-05-07T23:17:46","slug":"cms-2017-p2-part-b-obg","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/05\/08\/cms-2017-p2-part-b-obg\/","title":{"rendered":"CMS 2017 P2 Part-B OBG"},"content":{"rendered":"\n\n\n\n\n\n\n\nCMS 2017 Paper II \u2013 Part B (Q41\u2013Q80)<\/title>\n<link href=\"https:\/\/fonts.googleapis.com\/css2?family=Playfair+Display:wght@600;700&family=Source+Serif+4:ital,wght@0,300;0,400;0,600;1,400&display=swap\" rel=\"stylesheet\">\n<style>\n\/* \u2500\u2500 Namespace: cms17p2b \u2500\u2500 *\/\n#cms17p2b *,#cms17p2b *::before,#cms17p2b *::after{box-sizing:border-box;margin:0;padding:0}\n#cms17p2b{\n --ter:#C0603A;--ter-light:#e8825f;--ter-pale:#fdf1ec;\n --teal:#2A7A6F;--teal-light:#3da394;--teal-pale:#eaf4f3;\n --ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;\n --line:#e0d8d4;--bg:#fdfaf8;--white:#ffffff;\n --correct:#1e6f46;--correct-bg:#eaf7ef;--correct-border:#43a047;\n --wrong:#b83232;--wrong-bg:#fdf0f0;--wrong-border:#e53935;\n --radius:10px;\n font-family:'Source Serif 4',Georgia,serif;\n font-size:16px;color:var(--ink);background:var(--bg);\n line-height:1.7;padding:0 0 48px;\n}\n#cms17p2b .cq-sentinel{height:1px}\n#cms17p2b .cq-statusbar{position:fixed;top:0;left:0;right:0;z-index:99999;background:var(--white);border-bottom:2px solid var(--line);border-left:4px solid var(--ter);box-shadow:0 2px 12px rgba(0,0,0,0.11);opacity:0;pointer-events:none;transform:translateY(-110%);transition:opacity 0.22s ease,transform 0.22s ease;}\n#cms17p2b .cq-statusbar.visible{opacity:1;pointer-events:auto;transform:translateY(0)}\n#cms17p2b .cq-sb-stats{display:flex;align-items:center;padding:0.38rem 0.7rem;font-size:0.73rem;color:var(--ink-soft);}\n#cms17p2b .cq-sb-item{display:flex;align-items:center;gap:0.18rem;padding:0.1rem 0.5rem;border-right:1px 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.cq-band-c{background:var(--correct-bg);color:var(--correct)}\n#cms17p2b .cq-band-w{background:var(--wrong-bg);color:var(--wrong)}\n#cms17p2b .cq-band-s{background:var(--teal-pale);color:var(--teal)}\n#cms17p2b .cq-retry-btn{margin-top:22px;background:transparent;border:2px solid var(--teal);color:var(--teal);border-radius:8px;padding:10px 28px;font-family:'Playfair Display',serif;font-size:0.95rem;font-weight:700;cursor:pointer;transition:background 0.2s,color 0.2s;}\n#cms17p2b .cq-retry-btn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){\n #cms17p2b .cq-header h1{font-size:1.15rem}\n #cms17p2b .cq-qtext{font-size:0.88rem}\n #cms17p2b .cq-opt-text{font-size:0.84rem}\n}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms17p2b\">\n <div class=\"cq-sentinel\" id=\"cms17p2b-sentinel\"><\/div>\n <div class=\"cq-statusbar\" id=\"cms17p2b-statusbar\">\n <div class=\"cq-sb-stats\">\n <div class=\"cq-timer-item\" id=\"cms17p2b-timer-item\">\u23f1 <strong id=\"cms17p2b-timer-display\">40:00<\/strong><\/div>\n <div class=\"cq-sb-item\">\u2705 <strong id=\"cms17p2b-sc\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u274c <strong id=\"cms17p2b-sw\">0<\/strong><\/div>\n <div class=\"cq-sb-item\">\u23f3 <strong id=\"cms17p2b-sr\">40<\/strong> left<\/div>\n <div class=\"cq-sb-sep\"><\/div>\n <div class=\"cq-sb-item\">Net <strong id=\"cms17p2b-sn\">0<\/strong> \/ <strong id=\"cms17p2b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"cq-sb-progress\"><div class=\"cq-sb-fill\" id=\"cms17p2b-fill\"><\/div><\/div>\n <\/div>\n <div class=\"cq-grace\" id=\"cms17p2b-grace\">\n <div class=\"cq-grace-box\">\n <h3>Time's Up!<\/h3>\n <p>Submitting in<\/p>\n <div class=\"cq-grace-count\" id=\"cms17p2b-grace-count\">10<\/div>\n <button class=\"cq-grace-btn\" id=\"cms17p2b-grace-now\">Submit Now<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-header\">\n <h1>Combined Medical Services Examination 2017<br>Paper II \u00b7 Part B<\/h1>\n <p>Obstetrics & Gynaecology<\/p>\n <div class=\"cq-meta\">\n <span class=\"cq-badge\">Questions 41 \u2013 80<\/span>\n <span class=\"cq-badge\">Options reshuffled<\/span>\n <button class=\"cq-timer-btn\" id=\"cms17p2b-timer-btn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n <\/div>\n <div class=\"cq-body\">\n <div id=\"cms17p2b-questions\"><\/div>\n <div class=\"cq-submit-wrap\">\n <button class=\"cq-btn\" id=\"cms17p2b-submit\">Submit Answers<\/button>\n <\/div>\n <div class=\"cq-score\" id=\"cms17p2b-score\">\n <div class=\"cq-score-ring\" id=\"cms17p2b-ring\">\n <div class=\"cq-ring-inner\">\n <span class=\"cq-ring-pct\" id=\"cms17p2b-ring-pct\">0%<\/span>\n <span class=\"cq-ring-sub\">score<\/span>\n <\/div>\n <\/div>\n <h2>Your Result<\/h2>\n <div class=\"cq-net-line\" id=\"cms17p2b-net-line\"><\/div>\n <div class=\"cq-verdict\" id=\"cms17p2b-verdict\"><\/div>\n <div class=\"cq-score-bands\">\n <span class=\"cq-band cq-band-c\" id=\"cms17p2b-ct-c\"><\/span>\n <span class=\"cq-band cq-band-w\" id=\"cms17p2b-ct-w\"><\/span>\n <span class=\"cq-band cq-band-s\" id=\"cms17p2b-ct-s\"><\/span>\n <\/div>\n <button class=\"cq-retry-btn\" id=\"cms17p2b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n <\/div>\n<\/div>\n<script>\n(function(){\n 'use strict';\n const NS='cms17p2b', TOTAL=40, MAX=TOTAL*4;\n const TIMER_SECS=40*60, GRACE_SECS=10;\n\n const QUESTIONS=[\n {\n id:41,\n stem:'An infertile woman presents with yellow or green vaginal discharge, Bartholin cyst and proctitis. What is the most probable diagnosis?',\n correct:'Gonorrhoea',\n options:['Syphilis','Trichomoniasis','Gonorrhoea','Candidiasis'],\n exp:'The triad of purulent yellow-green vaginal discharge, Bartholin gland abscess\/cyst (Neisseria gonorrhoeae infects the duct of Bartholin\\'s gland causing abscess), and PROCTITIS (gonococcal rectal infection from ano-receptive intercourse or spread) is characteristic of GONORRHOEA (Neisseria gonorrhoeae). Gonorrhoea is the most common cause of Bartholin gland abscess. It also causes cervicitis, PID, and infertility (tubal occlusion). Syphilis causes painless ulcer and rash. Trichomonas causes frothy yellow-green discharge but no Bartholin involvement\/proctitis. Candidiasis causes curdy white discharge with pruritus. Bartholin abscess + proctitis = gonorrhoea.'\n },\n {\n id:42,\n stem:'Absolute contraindication to combined oral contraceptive is:',\n correct:'History of thrombo-embolism',\n options:['History of gestational diabetes mellitus','History of thrombo-embolism','History of previous two caesarean sections','History of gallbladder disease'],\n exp:'WHO Medical Eligibility Criteria Category 4 (absolute contraindications) for combined oral contraceptives include: history of thromboembolic disease (DVT\/PE) \u2014 oestrogen increases hepatic production of clotting factors II, VII, X, fibrinogen and reduces protein S, creating a prothrombotic state. Prior VTE is an absolute contraindication. History of GDM (Category 2 \u2014 benefits outweigh risks), previous caesarean sections (no increased risk from COC), and gallbladder disease (Category 3 \u2014 but not absolute contraindication unless current symptomatic gallbladder disease). Thromboembolism history = absolute contraindication.'\n },\n {\n id:43,\n stem:'A 28-year-old P1L1 is taken for laparotomy. On opening the abdomen, pseudomyxoma peritonei is present. What should be the probable reason?',\n correct:'Mucinous cystadenoma of ovary',\n options:['Mucinous cystadenoma of ovary','Serous cystadenoma of ovary','Rupture of dermoid tumour','Endometriosis'],\n exp:'Pseudomyxoma peritonei (PMP) is characterised by diffuse intraperitoneal mucinous ascites (\"jelly belly\") from rupture of a mucin-secreting tumour. In gynaecological practice, the ovarian source is a MUCINOUS CYSTADENOMA (or mucinous cystadenocarcinoma) of the ovary \u2014 rupture releases mucin-secreting epithelial cells that implant on peritoneal surfaces and continue secreting mucin. However, the appendix (low-grade appendiceal mucinous neoplasm, LAMN) is the most common primary source overall, often metastasising to the ovary. Among the given options, mucinous cystadenoma of the ovary is the correct answer. Serous, dermoid, and endometriosis do not cause PMP.'\n },\n {\n id:44,\n stem:'In a 40-year-old woman, Pap smear shows atypical glandular cells. The next step of management should be:',\n correct:'Colposcopy, cervical biopsy, endocervical curettage and endometrial biopsy',\n options:['Repeat Pap smear after three months','Colposcopic directed cervical biopsy','Colposcopy, cervical biopsy, endocervical curettage and endometrial biopsy','Hysteroscopy and directed endometrial biopsy'],\n exp:'Atypical Glandular Cells (AGC) on Pap smear is a high-risk cytological finding \u2014 it may represent endocervical adenocarcinoma in situ, invasive adenocarcinoma, or endometrial carcinoma. AGC has a higher association with significant pathology than ASC-US. Management requires comprehensive evaluation: COLPOSCOPY (to evaluate cervix and transformation zone) + CERVICAL BIOPSY (for CIN\/adenocarcinoma) + ENDOCERVICAL CURETTAGE (ECC, for endocervical lesions) + ENDOMETRIAL BIOPSY (especially in women \u226535 years or with abnormal bleeding, to exclude endometrial carcinoma). This comprehensive four-step evaluation is mandatory for AGC. Simple repeat Pap alone is inadequate.'\n },\n {\n id:45,\n stem:'A 50-year-old P4L4 has a simple left ovarian cyst of 10 cm. CA-125 is 30 U\/ml. Treatment of choice would be:',\n correct:'TAH + BSO',\n options:['TAH + BSO','Laparoscopic cystectomy','Laparoscopic oophorectomy','Medical management with oral contraceptives'],\n exp:'A post-menopausal woman (age 50, P4L4 likely perimenopausal\/postmenopausal) with a 10 cm ovarian cyst: any cyst >5 cm in a postmenopausal woman requires surgical intervention. Though CA-125 is 30 U\/ml (borderline normal\/slightly elevated \u2014 normal <35 U\/ml), a large 10 cm cyst in a postmenopausal woman warrants definitive surgery. TAH + BSO (Total Abdominal Hysterectomy + Bilateral Salpingo-Oophorectomy) is the treatment of choice \u2014 it removes both ovaries (bilateral, eliminating risk from the contralateral side), the uterus, and provides staging material. Simple cystectomy risks spillage of potential malignancy. In a postmenopausal woman who has completed family, TAH+BSO is definitive.'\n },\n {\n id:46,\n stem:'A seven-year-old girl with precocious puberty is found to have a 10 cm ovarian cyst on USG. The most likely aetiology is:',\n correct:'Granulosa cell tumour',\n options:['Benign cystic teratoma','Brenner tumour','Choriocarcinoma','Granulosa cell tumour'],\n exp:'Precocious puberty (isosexual, GnRH-independent) + ovarian cyst in a prepubertal girl = oestrogen-secreting ovarian tumour. GRANULOSA CELL TUMOUR is the most common ovarian sex-cord stromal tumour in children causing isosexual precocious puberty \u2014 it secretes oestrogen, causing premature breast development, pubic hair, and uterine bleeding in a girl under 8 years. The juvenile type of granulosa cell tumour is the classic cause of feminising precocious puberty. Benign cystic teratoma (dermoid) is non-functional. Brenner tumour is typically postmenopausal. Choriocarcinoma secretes hCG (not oestrogen, causes heterosexual precocity in males). Oestrogen + precocious puberty + child = granulosa cell tumour.'\n },\n {\n id:47,\n stem:'A 17-year-old girl presents with an ovarian cyst of 5 cm. The cyst is echo-free, unilocular and CA-125 is 8 U\/ml. What is the most appropriate management?',\n correct:'Conservative with follow-up ultrasound',\n options:['Laparoscopy for cyst removal','Laparotomy for cyst removal','Conservative with follow-up ultrasound','Medical treatment'],\n exp:'A simple, unilocular, anechoic (echo-free) ovarian cyst of 5 cm in a 17-year-old adolescent girl with normal CA-125 (8 U\/ml, well below 35 U\/ml) is almost certainly a benign functional cyst (follicular or corpus luteum). Management: CONSERVATIVE with follow-up ultrasound after 6\u20138 weeks (one to two menstrual cycles). The majority of functional cysts resolve spontaneously. Surgical intervention is not indicated for a simple, small, apparently benign cyst in a young girl \u2014 unnecessary surgery risks ovarian tissue loss and impairs future fertility. Intervention is warranted only if the cyst is complex, symptomatic, growing, or fails to regress after observation.'\n },\n {\n id:48,\n stem:'The contraceptive choice for a 38-year-old P1L1 woman having chronic hypertension, dysmenorrhoea and menorrhagia is:',\n correct:'Levonorgestrel intrauterine device',\n options:['Copper intrauterine device','Sterilisation','Levonorgestrel intrauterine device','Combined oral contraceptive pills'],\n exp:'This patient has three clinical needs: contraception, hypertension management (excluding oestrogen-containing methods), and treatment of dysmenorrhoea + menorrhagia. The LEVONORGESTREL IUS (Mirena, LNG-IUD) is ideal: (1) Highly effective contraception (99.8%). (2) No oestrogen \u2014 safe in hypertension (local progesterone, negligible systemic levels). (3) Reduces menorrhagia by 90% (thins endometrium). (4) Relieves dysmenorrhoea. (5) Long-acting (5 years), preserves fertility. COC is contraindicated (oestrogen in hypertension). Copper IUCD worsens menorrhagia and dysmenorrhoea. Sterilisation is permanent and she may want more children at 38. LNG-IUS addresses all three problems simultaneously.'\n },\n {\n id:49,\n stem:'Most probable cause of heavy bleeding in a P2L2 during the tenth post-partum day is:',\n correct:'Retained bits of cotyledons and membranes',\n options:['Retained bits of cotyledons and membranes','Subinvolution of placental site','Resumption of menstruation','Infected episiotomy wound'],\n exp:'Secondary post-partum haemorrhage (PPH) occurs 24 hours to 12 weeks after delivery. The most common cause on DAY 10 post-partum is RETAINED PLACENTAL TISSUE (bits of cotyledons and membranes). Retained tissue prevents normal uterine involution, keeps the placental sinuses open, and leads to heavy, persistent bleeding. It may also become infected. The uterus is larger than expected for the postpartum stage. Management: ultrasound confirmation + evacuation of retained products (ERPOC). Subinvolution of the placental site is the second most common cause but less likely than retained tissue on day 10. Resumption of menstruation does not occur at 10 days. Episiotomy infection causes local pain, not heavy uterine bleeding.'\n },\n {\n id:50,\n stem:'A woman with which of the following health problems should avoid centchroman?',\n correct:'Polycystic ovarian syndrome',\n options:['Polycystic ovarian syndrome','Woman with dysfunctional uterine bleeding','Endometrial hyperplasia','Endometriosis'],\n exp:'Centchroman (Saheli, ormeloxifene) is a non-steroidal, non-hormonal oral contraceptive \u2014 a selective oestrogen receptor modulator (SERM). It is taken weekly and has no hormonal side effects. It is CONTRAINDICATED in POLYCYSTIC OVARIAN SYNDROME (PCOS) because it can worsen oligomenorrhoea\/amenorrhoea by further inhibiting LH and disrupting the already irregular cycles in PCOS patients. In contrast, centchroman is actually BENEFICIAL in DUB, endometrial hyperplasia, and endometriosis \u2014 it has anti-oestrogenic effects on the endometrium, reducing endometrial proliferation. PCOS patients should use other contraceptive methods; centchroman may worsen their menstrual irregularity.'\n },\n {\n id:51,\n stem:'Combined contraceptive pills give protection from the following EXCEPT:',\n correct:'Cancer of cervix',\n options:['Cancer of ovary','Cancer of endometrium','Cancer of cervix','Ectopic pregnancy'],\n exp:'Protective effects of combined oral contraceptive pills: Ovarian cancer (40\u201350% risk reduction \u2014 suppression of ovulation reduces oncogenic stimulation of ovarian epithelium). Endometrial cancer (50% risk reduction \u2014 progestogen component opposes oestrogen stimulation of endometrium). Ectopic pregnancy (highly effective contraception, preventing both eutopic and ectopic implantation). Cancer of the CERVIX is NOT protected \u2014 in fact, long-term COC use (>5 years) is associated with a SLIGHT INCREASE in risk of cervical cancer (HPV cofactor effect, possibly through direct hormonal stimulation of HPV replication or reduced barrier protection). Cervical cancer is therefore the exception.'\n },\n {\n id:52,\n stem:'A woman presents with heavy foul-smelling discharge with sharply demarcated ulcers without induration on the perineum and labia majora. Inguinal lymphadenopathy is also present. What is the most probable diagnosis?',\n correct:'Chancroid',\n options:['Gonorrhoea','Tuberculosis','Chancroid','Trichomoniasis'],\n exp:'Chancroid (Haemophilus ducreyi): painful genital ulcers with SHARPLY DEMARCATED edges, soft (NOT indurated \u2014 unlike syphilitic chancre which is painless and indurated), with a necrotic, ragged, undermined base and FOUL-SMELLING purulent discharge. Painful inguinal lymphadenopathy (buboes) in 50% of cases. The soft, painful, non-indurated ulcer with foul discharge is the classic description distinguishing chancroid from syphilis (painless, indurated) and LGV (painless ulcer, prominent adenopathy). Tropical (soft sore) = chancroid. Gonorrhoea causes urethritis\/cervicitis without ulcers. Trichomonas causes frothy discharge without ulcers.'\n },\n {\n id:53,\n stem:'A 28-year-old woman develops amenorrhoea after having dilatation and curettage. The most likely diagnosis is:',\n correct:'Asherman syndrome',\n options:['Kallmann syndrome','Asherman syndrome','Anorexia nervosa','Turner syndrome'],\n exp:'Asherman syndrome (intrauterine adhesions\/synechiae): secondary amenorrhoea developing AFTER uterine instrumentation \u2014 dilatation and curettage (D&C, especially post-pregnancy when the endometrium is highly vulnerable), post-myomectomy, or post-hysteroscopic surgery. Aggressive curettage denudes the endometrium down to the basal layer, which then heals with fibrous adhesions obliterating the uterine cavity. Clinical features: secondary amenorrhoea, hypomenorrhoea, infertility, recurrent miscarriage, and cyclic pelvic pain (if outflow is blocked). Diagnosed by hysteroscopy (gold standard). Treatment: hysteroscopic adhesiolysis + oestrogen therapy for endometrial regeneration. The post-D&C context makes Asherman syndrome unmistakable.'\n },\n {\n id:54,\n stem:'Which of the following tests is NOT used for diagnosing syphilis?',\n correct:'Frei\\'s test',\n options:['Frei\\'s test','Direct fluorescent antibody test','FTA-ABS test','TPHA'],\n exp:'Syphilis (Treponema pallidum) diagnostic tests: Non-treponemal (screening): VDRL, RPR. Treponemal (confirmatory): FTA-ABS (fluorescent treponemal antibody absorption \u2014 highly specific), TPHA (T. pallidum haemagglutination assay), TPPA, EIA, and direct fluorescent antibody-T. pallidum (DFA-TP) for dark-field microscopy of ulcer exudate. FREI\\'S TEST (Frei intradermal skin test) was historically used for LYMPHOGRANULOMA VENEREUM (LGV, Chlamydia trachomatis L1\u2013L3) \u2014 it uses heat-killed Chlamydia antigen. It is NOT used for syphilis. Frei\\'s test = LGV. It is the exception in syphilis diagnosis.'\n },\n {\n id:55,\n stem:'Fitz-Hugh-Curtis syndrome involving perihepatitis is present in the following:',\n correct:'Gonorrhoea',\n options:['Moniliasis','Syphilis','Tuberculosis','Gonorrhoea'],\n exp:'Fitz-Hugh-Curtis syndrome is a complication of pelvic inflammatory disease characterised by PERIHEPATITIS \u2014 inflammation of the liver capsule (Glisson\\'s capsule) and adjacent peritoneum, causing right upper quadrant pain that can be confused with cholecystitis or pleuritis. It is caused by spread of GONORRHOEA (Neisseria gonorrhoeae) or Chlamydia trachomatis from the pelvis to the liver surface via the peritoneal cavity or lymphatics. \"Violin string adhesions\" between the liver surface and anterior abdominal wall are seen at laparoscopy. Gonorrhoea and Chlamydia are the two STIs causing this; among the options, gonorrhoea is the correct answer.'\n },\n {\n id:56,\n stem:'Which of the following cause\/causes bacterial vaginosis?\\n1. Gardnerella\\n2. Mycoplasma\\n3. Ureaplasma urealyticum\\n\\nSelect the correct answer:',\n correct:'1, 2 and 3',\n options:['1 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'Bacterial vaginosis (BV) is a polymicrobial condition characterised by replacement of normal Lactobacillus-dominant vaginal flora with a complex mix of anaerobes and facultative organisms. The organisms implicated include: Gardnerella vaginalis (the primary organism, produces the characteristic fishy amine odour; clue cells on wet mount), Mycoplasma hominis and Mycoplasma genitalium, Ureaplasma urealyticum, Mobiluncus species, Prevotella, Bacteroides, and Peptostreptococcus. All three listed organisms \u2014 Gardnerella (1), Mycoplasma (2), and Ureaplasma urealyticum (3) \u2014 are associated with BV. All three are correct.'\n },\n {\n id:57,\n stem:'Where are antisperm antibodies usually present?',\n correct:'Cervix',\n options:['Uterus','Vagina','Fallopian tube','Cervix'],\n exp:'Antisperm antibodies (ASA) in the female reproductive tract are predominantly found in CERVICAL MUCUS, produced by the secretory cells of the cervical crypts. Both IgG and IgA antisperm antibodies in cervical secretions agglutinate or immobilise sperm, preventing their penetration through the cervical mucus (impaired post-coital test). This is the main mechanism of immunological infertility in women. In men, ASA are found on sperm surfaces. The cervix is the primary site of ASA-mediated sperm dysfunction in female immunological infertility. Note: this question appeared identically as Q117 in CMS 2016 Paper II \u2014 same answer.'\n },\n {\n id:58,\n stem:'Modified Bishop\\'s score includes all EXCEPT:',\n correct:'Position of occiput',\n options:['Cervical length and dilatation','Consistency of cervix','Position of os','Position of occiput'],\n exp:'Bishop\\'s score assesses cervical favourability for induction of labour. Original Bishop\\'s score (5 parameters): dilatation, effacement (or length), station, consistency, and position of cervix (anterior\/mid\/posterior). Modified Bishop\\'s score uses: cervical DILATATION (0\u20133 cm), EFFACEMENT\/LENGTH (>4 cm to <0.5 cm), STATION (\u22123 to +2), CONSISTENCY (firm to soft), and POSITION OF OS (posterior to anterior). All five parameters relate to the CERVIX. POSITION OF OCCIPUT (fetal head presentation \u2014 OA, OP, LOT, etc.) is an obstetric parameter, NOT part of the Bishop\\'s score, which only assesses cervical characteristics. Occiput position is the exception.'\n },\n {\n id:59,\n stem:'The engaging diameter of brow presentation is:',\n correct:'Mento-vertical',\n options:['Mento-vertical','Submento-vertical','Suboccipito-bregmatic','Submento-bregmatic'],\n exp:'Engaging diameters of fetal presentations: Vertex (well-flexed) = Suboccipito-bregmatic = 9.5 cm (engages). Brow presentation (partial extension) = MENTO-VERTICAL = 13.5 cm (largest diameter, does NOT engage in a normal pelvis \u2014 brow presentation is incompatible with vaginal delivery in most cases and requires CS or spontaneous conversion). Face presentation (full extension) = Submento-bregmatic = 9.5 cm (can engage, delivered with chin anterior). Submento-vertical = 11.5 cm (face presentation with chin posterior, does not engage). Brow = mento-vertical = 13.5 cm = cannot engage in average pelvis.'\n },\n {\n id:60,\n stem:'Intramuscular injection of iron dextran is given by the \\'Z\\' technique to:',\n correct:'Reduce the staining',\n options:['Alleviate the pain','Decrease the incidence of infection','Reduce the staining','Increase the iron absorption'],\n exp:'The Z-track technique for IM iron dextran injection: the skin and subcutaneous tissue are pulled laterally (2\u20133 cm) before inserting the needle, the injection is given into the deep gluteal muscle, and the skin is released after withdrawal. This displaces the injection track, so when the skin recoils, there is no straight pathway for the iron to leak backwards through the tissue. The purpose is to REDUCE SKIN STAINING \u2014 iron dextran causes permanent brownish-black tattooing of the skin if it leaks along the needle track into the subcutaneous tissue. It does not primarily affect pain, infection risk, or absorption. Reducing iron staining of the skin is the specific purpose of the Z-track technique.'\n },\n {\n id:61,\n stem:'Which of the following is\/are the risk factors for acute pelvic inflammatory disease in women?\\n1. Intercourse during menstruation\\n2. Multiple sex partners\\n\\nSelect the correct answer:',\n correct:'Both 1 and 2',\n options:['1 only','2 only','Both 1 and 2','Neither 1 nor 2'],\n exp:'Risk factors for acute PID: (1) Intercourse during menstruation \u2014 the cervical os is open during menstruation, and the absence of cervical mucus plug (which normally acts as a mechanical barrier) allows ascending bacterial infection more easily. Blood is also a good culture medium for pathogens. (2) Multiple sexual partners \u2014 increases exposure to gonorrhoea and chlamydia, the primary causative organisms of PID. Other risk factors: young age (<25), previous PID, IUCD insertion, bacterial vaginosis, and smoking. Both statements 1 and 2 are recognised risk factors for PID. Both are correct.'\n },\n {\n id:62,\n stem:'The umbilical cord normally contains:',\n correct:'Two arteries and one vein',\n options:['Two arteries and two veins','One artery and one vein','Two arteries and one vein','One artery and two veins'],\n exp:'The normal umbilical cord contains THREE vessels: TWO UMBILICAL ARTERIES (carrying deoxygenated blood and waste from the fetus to the placenta) and ONE UMBILICAL VEIN (carrying oxygenated, nutrient-rich blood from the placenta to the fetus). They are embedded in Wharton\\'s jelly (a mucoid connective tissue). A single umbilical artery (two-vessel cord) occurs in approximately 1% of pregnancies and is associated with renal anomalies and chromosomal abnormalities. The mnemonic is \"AVA\" \u2014 Artery, Vein, Artery (or \"2 arteries, 1 vein\"). Always a favourite examination question.'\n },\n {\n id:63,\n stem:'Painless genital ulcer is found in which one of the following genital infections?',\n correct:'Lymphogranuloma venereum',\n options:['Granuloma inguinale','Chancroid','Lymphogranuloma venereum','Herpes simplex'],\n exp:'Genital ulcer characteristics: Syphilis (primary chancre) = painless, indurated, clean base. LGV (Chlamydia trachomatis, L1\u2013L3) = small, shallow, PAINLESS, transient ulcer (often unnoticed) followed by inguinal bubo. Chancroid = painful, soft, ragged, foul-smelling. Herpes simplex = painful, multiple vesicles\/shallow ulcers. Granuloma inguinale (donovanosis) = painless, beefy-red, raised, non-ulcerative lesion (pseudoulcer). Among the options, LGV has a painless initial ulcer (the primary stage is a small painless papule\/pustule that rapidly ulcerates and heals unnoticed \u2014 the presentation is predominantly the secondary stage inguinal syndrome with buboes). LGV = painless genital ulcer.'\n },\n {\n id:64,\n stem:'Medical management of tubal ectopic pregnancy can be done in the following EXCEPT:',\n correct:'\u03b2-hCG level more than 10,000 IU',\n options:['Period of gestation 5 weeks','\u03b2-hCG level more than 10,000 IU','Absent foetal cardiac activity','Gestational sac diameter 3 cm'],\n exp:'Criteria for medical management of ectopic pregnancy with methotrexate (MTX): Haemodynamically stable, unruptured ectopic, \u03b2-hCG <5,000 IU\/L (some protocols accept up to 10,000 but with caution), no fetal cardiac activity (fetal heartbeat = contraindication), gestational sac \u22643.5 cm, no intrauterine pregnancy, normal renal\/hepatic\/haematological function, compliant patient. \u03b2-hCG >10,000 IU\/L is an absolute contraindication to MTX \u2014 high hCG predicts treatment failure (>50% failure rate), indicating a well-developed trophoblast requiring surgical intervention. Early gestation (5 weeks), absent cardiac activity, and 3 cm sac are all within medical management criteria. Only \u03b2-hCG >10,000 IU is a contraindication.'\n },\n {\n id:65,\n stem:'Cholestasis of pregnancy may lead to the following complications EXCEPT:',\n correct:'Neonatal jaundice',\n options:['Intrauterine foetal death','Meconium-stained liquor','Preterm labour','Neonatal jaundice'],\n exp:'Intrahepatic cholestasis of pregnancy (ICP\/obstetric cholestasis): maternal complications \u2014 pruritus, jaundice. Fetal\/obstetric complications: intrauterine fetal death (IUFD \u2014 sudden, unpredictable; related to bile salt toxicity to fetal myocardium), meconium-stained liquor (bile salt-induced increased fetal gut motility), and preterm labour (spontaneous or iatrogenic early delivery to prevent IUFD). NEONATAL JAUNDICE is NOT a direct complication of maternal ICP \u2014 bile salts that cross the placenta are handled by the fetal liver and do not cause neonatal cholestasis. The neonate may have transient mild hyperbilirubinaemia but neonatal jaundice is NOT a recognised specific complication of maternal ICP. It is the exception.'\n },\n {\n id:66,\n stem:'Which of the following genital infections is associated with preterm labour?',\n correct:'Bacterial vaginosis',\n options:['Human Papilloma Virus','Trichomonas vaginalis','Monilial vaginitis','Bacterial vaginosis'],\n exp:'BACTERIAL VAGINOSIS (BV) is the genital infection most strongly associated with preterm labour and preterm premature rupture of membranes (PPROM). The polymicrobial flora of BV produces phospholipases (activating arachidonic acid \u2192 prostaglandin synthesis \u2192 uterine contractions) and proteases (degrading fetal membranes). BV doubles the risk of preterm birth. HPV causes cervical dysplasia\/condylomata \u2014 no direct link to preterm labour. Trichomonas vaginalis has a weak association. Candidal vaginitis is not associated with preterm labour. BV is the single most important STI\/vaginal infection associated with preterm birth.'\n },\n {\n id:67,\n stem:'Multiple pregnancy is associated with an increased incidence of the following EXCEPT:',\n correct:'Post-date pregnancy',\n options:['Hyperemesis gravidarum','Congenital malformations','Pregnancy-induced hypertension','Post-date pregnancy'],\n exp:'Multiple pregnancies are associated with INCREASED incidence of: hyperemesis gravidarum (increased hCG from multiple placentas), congenital malformations (especially monozygotic twins \u2014 higher rate of structural defects), pregnancy-induced hypertension\/pre-eclampsia (larger placental mass, ischaemia), anaemia, polyhydramnios, placenta praevia, preterm labour, malpresentation, PPH, and perinatal mortality. POST-DATE PREGNANCY (>42 weeks) is NOT associated with multiple pregnancy \u2014 in fact, multiple pregnancies consistently deliver EARLIER than singletons (preterm delivery is a hallmark). Multiple pregnancies do not go post-dates. Post-date is the exception.'\n },\n {\n id:68,\n stem:'Which of the following conditions of the endometrium is associated with a significantly increased risk of development of cancer?',\n correct:'Complex hyperplasia with atypia',\n options:['Simple hyperplasia','Complex hyperplasia with atypia','Simple atypical hyperplasia','Complex hyperplasia'],\n exp:'Endometrial hyperplasia and cancer risk (WHO classification): Simple hyperplasia without atypia \u2014 1% risk of progression to cancer. Complex hyperplasia without atypia \u2014 3% risk. Simple atypical hyperplasia \u2014 8% risk. COMPLEX HYPERPLASIA WITH ATYPIA \u2014 approximately 29% risk (some studies report up to 52%) of progression to endometrial carcinoma. Cytological atypia (nuclear enlargement, irregular chromatin) combined with complex architectural changes (back-to-back glands, branching) represents the highest risk precancerous lesion. It is essentially carcinoma in situ of the endometrium and requires hysterectomy in women who have completed childbearing. Complex hyperplasia with atypia has the highest malignant potential.'\n },\n {\n id:69,\n stem:'Surgical staging is done for all the genital malignancies EXCEPT:',\n correct:'Gestational trophoblastic neoplasia',\n options:['Ovarian malignancy','Gestational trophoblastic neoplasia','Endometrial carcinoma','Fallopian tube malignancy'],\n exp:'FIGO staging of genital malignancies: Ovarian carcinoma = SURGICAL staging (laparotomy\/laparoscopy with peritoneal washings, omental biopsy, lymph node sampling). Endometrial carcinoma = SURGICAL staging (hysterectomy + BSO + lymph node dissection). Fallopian tube carcinoma = SURGICAL staging (same as ovarian). GESTATIONAL TROPHOBLASTIC NEOPLASIA (GTN \u2014 hydatidiform mole, choriocarcinoma, PSTT) uses CLINICAL staging \u2014 the FIGO clinical staging system based on tumour markers (hCG levels), clinical\/imaging findings, and risk scoring. GTN does NOT require surgical staging \u2014 it is staged and treated based on hCG levels, metastases on imaging, and clinical risk factors. GTN is the exception.'\n },\n {\n id:70,\n stem:'B-Lynch suture for atonic post-partum haemorrhage:',\n correct:'Compresses the uterus',\n options:['Compresses the uterus','Ligates the uterine arteries','Ligates the utero-ovarian anastomosis','Ligates the ovarian vessels'],\n exp:'B-Lynch suture (Christopher B-Lynch, 1997) is a UTERINE COMPRESSION SUTURE \u2014 it physically compresses the uterine body longitudinally, reducing the surface area of the placental site and achieving haemostasis in atonic PPH. The suture passes over the uterine fundus in a brace-like configuration, compressing the anterior and posterior walls together. It is a fertility-preserving surgical option when medical management fails and before proceeding to hysterectomy. It compresses (not ligates) the uterus \u2014 mechanical compression reduces blood flow through the open sinuses. O\\'Leary sutures = uterine artery ligation. Ovarian vessel ligation is a separate procedure.'\n },\n {\n id:71,\n stem:'Regarding DeLancey\\'s levels of vaginal support, consider the following pairs:\\n1. Level I \u2014 Supports distal urethra\/perineal body\\n2. Level II \u2014 Supports mid-vagina\\n3. Level III \u2014 Supports apical defect\\n\\nWhich of the pairs given above is\/are correctly matched?',\n correct:'2 only',\n options:['1 and 3 only','2 only','2 and 3 only','1, 2 and 3'],\n exp:'DeLancey\\'s levels of vaginal support (1992): Level I (Apical suspension) \u2014 uterosacral and cardinal ligaments support the VAGINAL APEX and uterus (not distal urethra). Level II (Lateral attachment) \u2014 arcus tendineus fasciae pelvis (ATFP) and levator ani support the MID-VAGINA bilaterally (prevents lateral wall prolapse\/paravaginal defect) \u2014 statement 2 is CORRECT. Level III (Distal fusion) \u2014 perineal body and perineal membrane support the DISTAL VAGINA, distal urethra, and perineum. Statements 1 and 3 have the descriptions REVERSED. Statement 1 describes Level III. Statement 3 describes Level I. Only statement 2 (Level II = mid-vagina) is correctly matched.'\n },\n {\n id:72,\n stem:'Regarding conjoined twins, which of the following statements is\/are true?\\n1. These are always monozygotic\\n2. These result when division occurs before the embryonic disc is formed\\n3. Most common variety is thoracopagus\\n\\nSelect the correct answer:',\n correct:'1 and 3 only',\n options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],\n exp:'(1) Conjoined twins are ALWAYS MONOZYGOTIC (identical, from one fertilised egg) \u2014 they arise from incomplete separation of a single embryo. Statement 1 is CORRECT. (2) Conjoined twins result when division occurs AFTER the embryonic disc is formed (approximately day 13\u201315 of development \u2014 very late incomplete division of a monozygotic embryo). Division BEFORE the embryonic disc (day 4\u20138) produces normal separate identical twins. Statement 2 is WRONG. (3) THORACOPAGUS (joined at the chest\/thorax, sharing the heart) is the MOST COMMON type of conjoined twins (~40% of cases). Statement 3 is CORRECT. Statements 1 and 3 are correct.'\n },\n {\n id:73,\n stem:'The appropriate treatment for the baby of a woman who is HBsAg positive but HBeAg negative is:',\n correct:'Both active and passive immunisation soon after birth',\n options:['Both active and passive immunisation soon after birth','Passive immunisation soon after birth but active immunisation after one year of age','Only active immunisation soon after birth','Only passive immunisation soon after birth'],\n exp:'For infants born to HBsAg-positive mothers: BOTH active immunisation (HBV vaccine, first dose) AND passive immunisation (HBIG, hepatitis B immunoglobulin 0.5 mL IM) should be given within 12 hours of birth, at different injection sites. This combination prevents vertical transmission in >90% of cases. HBeAg status modifies risk level (HBeAg positive = higher transmission risk ~90%; HBeAg negative = lower risk ~10\u201340%) but does NOT change the management \u2014 both active + passive immunisation are given regardless of maternal HBeAg status. Delaying active immunisation to 1 year is incorrect \u2014 it must be given at birth for optimal protection.'\n },\n {\n id:74,\n stem:'Consider the following pairs regarding foetal heart during labour:\\n1. Early decelerations \u2014 Most common during labour and are due to cord compression\\n2. Late decelerations \u2014 Result from any process leading to maternal hypotension, placental insufficiency or excessive uterine activity\\n3. Variable decelerations \u2014 Due to head compression leading to vagal stimulation\\n\\nWhich of the pairs given above is\/are correctly matched?',\n correct:'2 only',\n options:['1 and 2','2 and 3','1 and 3','2 only'],\n exp:'FHR deceleration types: (1) Early decelerations \u2014 uniform, mirror contractions, due to FETAL HEAD COMPRESSION (vagal reflex) \u2014 NOT cord compression. Statement 1 is WRONG (it confuses early with variable). (2) Late decelerations \u2014 begin after peak of contraction, result from uteroplacental insufficiency (maternal hypotension, placental dysfunction, excessive uterine activity reducing placental perfusion) \u2014 statement 2 is CORRECT. (3) Variable decelerations \u2014 abrupt onset\/offset, most common type in labour, due to UMBILICAL CORD COMPRESSION \u2014 NOT head compression. Statement 3 is WRONG (it confuses variable with early). Only statement 2 is correctly matched.'\n },\n {\n id:75,\n stem:'A 26-year-old woman P1L1 reports with High Grade Squamous Intraepithelial Lesion (HGSIL) on Pap smear. Further management for her is:',\n correct:'Colposcopy and directed biopsy',\n options:['VIA, VILI','Colposcopy and directed biopsy','LEEP','Conisation'],\n exp:'HGSIL (CIN II\/III equivalent) on Pap smear in a young woman: the NEXT STEP is COLPOSCOPY AND COLPOSCOPY-DIRECTED BIOPSY to histologically confirm the grade of CIN and extent of lesion before definitive treatment. Pap smear is a screening tool \u2014 histological confirmation by biopsy is mandatory before treatment. LEEP (Loop Electrosurgical Excision Procedure) or conisation are THERAPEUTIC procedures done after biopsy confirmation, not as the first step. VIA\/VILI are alternative visual inspection methods used in low-resource settings when colposcopy is unavailable. For HGSIL in a facility with colposcopy, colposcopy + directed biopsy is the standard next step.'\n },\n {\n id:76,\n stem:'With reference to displacement of the uterus, the treatment of choice for genuine stress urinary incontinence is:',\n correct:'TVT-O mid-urethral tape',\n options:['Kegel\\'s perineal exercises','Kelly\\'s plication','TVT-O mid-urethral tape','Periurethral injection of bulking agents'],\n exp:'Genuine stress urinary incontinence (SUI) treatment: Kegel\\'s exercises (pelvic floor muscle training) \u2014 first-line conservative management, mild SUI. Kelly\\'s plication (anterior colporrhaphy\/bladder neck plication) \u2014 historical surgical procedure, high recurrence rate (~50% at 5 years), not recommended as primary surgical treatment. TVT-O (Tension-free Vaginal Tape-Obturator, or any mid-urethral tape\/sling procedure) \u2014 current GOLD STANDARD surgical treatment for genuine SUI with the best long-term cure rates (>80% at 5 years, minimally invasive, day-case procedure). Periurethral injections (bulking agents) \u2014 third-line, for frail\/elderly patients. TVT-O mid-urethral tape is the treatment of choice for genuine SUI requiring surgery.'\n },\n {\n id:77,\n stem:'Regarding placental separation in the 3rd stage of labour, consider the following statements:\\n1. Separation of placenta occurs at the decidua spongiosa\\n2. In Schultze\\'s method, separation of placenta starts at the centre\\n3. In Mathew Duncan\\'s method, separation begins at the margin\\n\\nWhich of the statements given above is\/are correct?',\n correct:'1, 2 and 3',\n options:['1 only','1 and 2 only','2 and 3 only','1, 2 and 3'],\n exp:'All three statements are correct: (1) Placental separation occurs at the DECIDUA SPONGIOSA (the middle spongy layer of the decidua basalis) \u2014 shearing forces at this layer separate the placenta from the uterine wall. (2) Schultze\\'s method (more common, ~80%): separation begins at the CENTRE of the placenta (retroplacental haematoma forms centrally), and the placenta slides out foetal surface first (shiny surface first) \u2014 the mechanism produces a gush of blood after placental delivery. (3) Mathew Duncan\\'s method (less common, ~20%): separation begins at the MARGIN of the placenta, sliding sideways (maternal surface first, dull appearance) with continuous blood loss during separation. All three statements are correct.'\n },\n {\n id:78,\n stem:'A 16-year-old girl presents with primary amenorrhoea with absent vagina, cervix and uterus in the presence of normal secondary sexual characteristics. Ovaries are present on USG. The most probable diagnosis is:',\n correct:'Mayer-Rokitansky-K\u00fcster-Hauser syndrome',\n options:['Klinefelter\\'s syndrome','Androgen insensitivity syndrome','Mayer-Rokitansky-K\u00fcster-Hauser syndrome','Prader-Willi syndrome'],\n exp:'MRKH syndrome: 46,XX karyotype, normal secondary sexual characteristics (normal oestrogen from normal ovaries), but absent vagina, cervix, and uterus (M\u00fcllerian aplasia). Ovaries are present and functional (hence normal pubertal development). Presents with primary amenorrhoea. Compare with Androgen Insensitivity Syndrome (AIS): 46,XY, also has absent vagina\/uterus, but NO pubic\/axillary hair (androgen insensitivity), testes in inguinal region (not ovaries). The presence of NORMAL SECONDARY SEXUAL CHARACTERISTICS + OVARIES on USG + absent uterus\/vagina = MRKH (46,XX). AIS has absent body hair. Klinefelter\\'s = 47,XXY, male. Prader-Willi = obesity, hypogonadism, intellectual disability.'\n },\n {\n id:79,\n stem:'A 32-year-old woman has 1200 cc of blood loss following a spontaneous vaginal delivery and delivery of placenta. The uterine fundus is palpated and noted to be firm. Which of the following is the most likely treatment for this patient?',\n correct:'Surgical repair of cervical tear',\n options:['B-Lynch suture','Surgical repair of cervical tear','Intramuscular prostaglandin','Replacement of inverted uterus'],\n exp:'Post-partum haemorrhage (PPH) with a FIRM uterus after delivery of the placenta = the uterus is well contracted (NOT atonic). The bleeding is therefore NOT from uterine atony. With a contracted uterus, the cause of PPH must be GENITAL TRACT TRAUMA \u2014 lacerations of the cervix, vagina, or perineum. With 1200 cc of blood loss and a firm uterus, CERVICAL TEAR (cervical laceration) is the most likely diagnosis. Management: thorough inspection of the cervix (using sims speculum and ring forceps), followed by SURGICAL REPAIR of the cervical tear. B-Lynch suture and prostaglandins treat atonic PPH. Uterine replacement is for inversion. Firm uterus + PPH = trauma\/laceration.'\n },\n {\n id:80,\n stem:'Which of the following statements is\/are correct regarding physiology of menstruation?\\n1. LH surge precedes ovulation\\n2. There are two peaks in serum oestradiol levels, first in follicular and second in luteal phase\\n3. 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Submitting in 10 Submit Now Combined Medical Services Examination 2017Paper II \u00b7 Part B Obstetrics & Gynaecology Questions 41 \u2013 80 Options reshuffled \u23f1 Start Timed Mode Submit Answers 0% score Your Result \u21ba Retry Quiz<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"neve_meta_sidebar":"","neve_meta_container":"","neve_meta_enable_content_width":"","neve_meta_content_width":0,"neve_meta_title_alignment":"","neve_meta_author_avatar":"","neve_post_elements_order":"","neve_meta_disable_header":"","neve_meta_disable_footer":"","neve_meta_disable_title":"","footnotes":""},"categories":[18,55],"tags":[],"class_list":["post-36777","post","type-post","status-publish","format-standard","hentry","category-cms","category-obg"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>CMS 2017 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\/08\/cms-2017-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 2017 P2 Part-B OBG - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2017 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! 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