CMS 2018 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#cms18p2b*,#cms18p2b *::before,#cms18p2b *::after{box-sizing:border-box;margin:0;padding:0}\n#cms18p2b{--ter:#C0603A;--ter-pale:#fdf1ec;--teal:#2A7A6F;--tl:#3da394;--tp:#eaf4f3;--ink:#1a1a1a;--im:#444;--is:#777;--ln:#e0d8d4;--bg:#fdfaf8;--wh:#fff;--cb:#43a047;--cbg:#eaf7ef;--wb:#e53935;--wbg:#fdf0f0;--r:10px;font-family:'Source Serif 4',Georgia,serif;font-size:16px;color:var(--ink);background:var(--bg);line-height:1.7;padding:0 0 48px}\n#cms18p2b .sn{height:1px}\n#cms18p2b .sb{position:fixed;top:0;left:0;right:0;z-index:99999;background:var(--wh);border-bottom:2px solid var(--ln);border-left:4px solid var(--ter);box-shadow:0 2px 12px rgba(0,0,0,.11);opacity:0;pointer-events:none;transform:translateY(-110%);transition:opacity .22s,transform 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var(--teal);color:var(--teal);border-radius:8px;padding:10px 28px;font-family:'Playfair Display',serif;font-size:.95rem;font-weight:700;cursor:pointer;transition:background .2s,color .2s}\n#cms18p2b .rb:hover{background:var(--teal);color:var(--wh)}\n@media(max-width:480px){#cms18p2b .hd h1{font-size:1.15rem}#cms18p2b .qt{font-size:.88rem}#cms18p2b .ox{font-size:.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms18p2b\">\n<div class=\"sn\" id=\"cms18p2b-sn\"><\/div>\n<div class=\"sb\" id=\"cms18p2b-sb\">\n <div class=\"sr\">\n <div class=\"ti\" id=\"cms18p2b-ti\">\u23f1 <strong id=\"cms18p2b-td\">40:00<\/strong><\/div>\n <div class=\"si\">\u2705 <strong id=\"cms18p2b-sc\">0<\/strong><\/div>\n <div class=\"si\">\u274c <strong id=\"cms18p2b-sw\">0<\/strong><\/div>\n <div class=\"si\">\u23f3 <strong id=\"cms18p2b-sr\">40<\/strong> left<\/div>\n <div class=\"ss\"><\/div>\n <div class=\"si\">Net <strong id=\"cms18p2b-sn\">0<\/strong> \/ <strong id=\"cms18p2b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"sp\"><div class=\"sf\" id=\"cms18p2b-sf\"><\/div><\/div>\n<\/div>\n<div class=\"gr\" id=\"cms18p2b-gr\">\n <div class=\"gb\"><h3>Time's Up!<\/h3><p>Submitting in<\/p><div class=\"gc\" id=\"cms18p2b-gc\">10<\/div><button class=\"gn\" id=\"cms18p2b-gn\">Submit Now<\/button><\/div>\n<\/div>\n<div class=\"hd\">\n <h1>Combined Medical Services Examination 2018<br>Paper II \u00b7 Part B<\/h1>\n <p>Obstetrics & Gynaecology<\/p>\n <div class=\"mt\">\n <span class=\"bd\">Questions 41 \u2013 80<\/span>\n <span class=\"bd\">Options reshuffled<\/span>\n <button class=\"tb\" id=\"cms18p2b-tb\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"bd2\">\n <div id=\"cms18p2b-qs\"><\/div>\n <div class=\"sw\"><button class=\"bt\" id=\"cms18p2b-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms18p2b-sc-box\">\n <div class=\"rg\" id=\"cms18p2b-rg\"><div class=\"ri\"><span class=\"rp\" id=\"cms18p2b-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms18p2b-nl\"><\/div>\n <div class=\"vd\" id=\"cms18p2b-vd\"><\/div>\n <div class=\"bs\"><span class=\"bn bc\" id=\"cms18p2b-bc\"><\/span><span class=\"bn bw\" id=\"cms18p2b-bw\"><\/span><span class=\"bn bk\" id=\"cms18p2b-bk\"><\/span><\/div>\n <button class=\"rb\" id=\"cms18p2b-rb\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms18p2b',TOTAL=40,MAX=160,TSECS=2400,GSECS=10;\nvar QS=[\n{id:41,stem:'Consider haemodynamic changes during pregnancy:\\n1. Increase in cardiac output\\n2. Increase in stroke volume\\n3. Increase in colloid oncotic pressure\\n4. Increase in pulse rate\\nWhich are correct?',correct:'1, 2 and 4',options:['1, 3 and 4','1, 2 and 4','1, 2 and 3','2, 3 and 4'],exp:'Cardiac output \u2191 (30\u201350%, peaks 28\u201332 wks). Stroke volume \u2191 (~30% \u2014 increased preload, reduced afterload). Pulse rate \u2191 (10\u201315 bpm above baseline). Colloid oncotic pressure: DECREASES \u2014 albumin is diluted by expanded plasma volume \u2192 lower oncotic pressure \u2192 predisposes to oedema. Statement 3 is FALSE. Correct: 1, 2 and 4.'},\n{id:42,stem:'Which of the following are hypotheses for onset of Labour?\\n1. Uterine distension\\n2. Activation of fetal HPA axis\\n3. Increase in prostaglandins\\n4. Increase in serum calcium levels\\nSelect correct answer:',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1 and 3 only','2, 3 and 4'],exp:'Uterine distension \u2714 \u2014 stretching activates prostaglandin release and gap junctions. Fetal HPA axis activation \u2714 \u2014 fetal cortisol drives oestrogen synthesis, shifts E:P ratio, upregulates oxytocin receptors. Prostaglandins (PGE2, PGF2\u03b1) \u2714 \u2014 ripen cervix, stimulate contractions. Serum calcium: NOT a recognised hypothesis for labour onset; calcium mediates intracellular contraction but rising serum Ca is not a trigger. Statement 4 FALSE. Correct: 1, 2 and 3.'},\n{id:43,stem:'Which statements regarding Puerperal sepsis are correct?\\n1. Multiple PV examinations increase the risk\\n2. Responsible organisms are Group A and B beta-haemolytic Streptococcus\\n3. Retained bits of placenta and membrane predispose\\n4. Vaginal packing can decrease the risk\\nSelect correct answer:',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'(1) Multiple PV exams \u2714 \u2014 each exam introduces vaginal flora into the uterine cavity; key preventable cause of puerperal sepsis. (2) Group A beta-haemolytic Streptococcus \u2714 (classic \u2014 Semmelweis; S. pyogenes); Group B Strep also implicated. (3) Retained placental\/membrane fragments \u2714 \u2014 nidus for bacterial growth, predispose to endometritis. (4) Vaginal packing does NOT decrease risk \u2014 retained packs are a risk factor for infection. Statement 4 FALSE. Correct: 1, 2 and 3.'},\n{id:44,stem:'In labour complicated with cord prolapse, which statements are correct?\\n1. Reposition patient in exaggerated Sims position\\n2. Replace the cord in the vagina\\n3. Replace the cord inside the uterus\\n4. Early amniotomy can prevent cord prolapse\\nSelect correct answer:',correct:'1 and 2 only',options:['1, 2, 3 and 4','1 and 2 only','1, 2 and 3 only','3 and 4 only'],exp:'(1) Exaggerated Sims or knee-chest position \u2714 \u2014 gravity relieves cord compression. (2) Replace cord IN THE VAGINA \u2714 \u2014 kept warm and moist; minimise handling to prevent spasm; do NOT leave outside. (3) Replace cord INSIDE uterus \u2014 NOT recommended; attempted funic reduction risks trauma and is not standard practice. (4) Early amniotomy INCREASES cord prolapse risk (intact membranes cushion the cord; ARM before engagement is dangerous). Statements 3 and 4 FALSE. Correct: 1 and 2 only.'},\n{id:45,stem:'The following are contents of the broad ligament EXCEPT:',correct:'Internal iliac artery',options:['Fallopian tube','Uterine and ovarian arteries with their branches','Ovarian ligament','Internal iliac artery'],exp:'Broad ligament contents: Fallopian tube \u2714 (mesosalpinx \u2014 upper free edge), Uterine artery branches \u2714 (crosses ureter \u2014 \"water under the bridge\"), Ovarian artery branches \u2714 (in mesovarium), Ovarian ligament \u2714 (connects ovary to uterus), Round ligament, ureter, lymphatics, parametrial tissue. INTERNAL ILIAC ARTERY: runs on the lateral pelvic wall \u2014 NOT contained within the broad ligament. The uterine artery arises from it and enters the broad ligament; the internal iliac itself remains on the pelvic sidewall. Answer: Internal iliac artery.'},\n{id:46,stem:'Which one of the following is true regarding normal menstrual physiology?',correct:'Threshold of LH surge generally persists for 48 hours',options:['Ovulation occurs after 48 hours of LH surge','Oestradiol levels peak at 48 hours prior to ovulation','Ovulation occurs after 12 hours of LH peak','Threshold of LH surge generally persists for 48 hours'],exp:'LH surge: initiated by oestradiol peak (which precedes surge by 24\u201336 h); threshold of LH surge persists ~48 hours \u2714 \u2014 standard textbook statement. Ovulation: occurs 34\u201338 h after ONSET of LH surge, or 10\u201312 h after LH PEAK (option c says 12 h after LH peak \u2014 approximately correct, but the 48-hour persistence is the more standard textbook statement). Oestradiol peaks ~24\u201336 h BEFORE ovulation (not exactly 48 h before). The most precisely correct statement among the options: \"Threshold of LH surge persists for 48 hours.\" Answer: Threshold of LH surge persists for 48 hours.'},\n{id:47,stem:'Which one of the following is NOT a feature of Candida Vaginitis?',correct:'Metronidazole is the treatment of choice',options:['Pruritus is out of proportion to discharge','Discharge is thick and curdy','Yeast-buds and pseudohyphae can be seen under microscope','Metronidazole is the treatment of choice'],exp:'Candida vaginitis (Candida albicans): Pruritus \u2714 \u2014 intense vulval itching, out of proportion to discharge. Discharge \u2714 \u2014 thick, white, curdy\/cottage-cheese, non-offensive. Microscopy \u2714 \u2014 KOH prep shows budding yeast (blastospores) and pseudohyphae. pH normal (<4.5). Treatment: FLUCONAZOLE (oral 150 mg single dose) or topical azoles (clotrimazole, miconazole). METRONIDAZOLE: treats Bacterial Vaginosis (Gardnerella) and Trichomonas \u2014 NO activity against Candida (a fungus). Answer: Metronidazole is the treatment \u2014 NOT a feature.'},\n{id:48,stem:'Which of the following is NOT a high risk factor for developing endometrial carcinoma?',correct:'Multiparity',options:['Delayed menopause','Hypertension','Multiparity','Obesity'],exp:'Risk factors for Type I endometrial carcinoma (oestrogen-dependent): Obesity \u2714 (peripheral aromatisation in adipose tissue), Delayed menopause \u2714 (prolonged oestrogen exposure), Hypertension \u2714 (part of metabolic syndrome \u2014 obesity-HTN-DM cluster), Nulliparity, PCOS, Diabetes, Tamoxifen. MULTIPARITY: PROTECTIVE \u2014 each full-term pregnancy provides a progestin-dominant phase (corpus luteum progesterone) counterbalancing oestrogen. Multiparous women have LOWER risk. Nulliparity = risk; Multiparity = protective. Answer: Multiparity \u2014 NOT a high risk factor.'},\n{id:49,stem:'All of the following are features of functional ovarian cyst EXCEPT:',correct:'Usually symptomatic',options:['Usually < 7 cm in diameter','Spontaneous regression occurs','Unilocular','Usually symptomatic'],exp:'Functional ovarian cysts (follicular, corpus luteum, theca-lutein): <7 cm \u2714 (follicular rarely >8 cm). Spontaneous regression \u2714 \u2014 hallmark; most resolve within 1\u20133 menstrual cycles. Unilocular \u2714 \u2014 thin-walled, simple, no internal echoes on USS. SYMPTOMS: functional cysts are typically ASYMPTOMATIC \u2014 incidental USS findings. They are NOT usually symptomatic; symptoms arise only from complications (torsion, rupture, haemorrhage). \"Usually symptomatic\" = NOT a feature. Answer: Usually symptomatic.'},\n{id:50,stem:'Gestational trophoblastic disease spectrum comprises:\\n1. Complete Hydatidiform mole\\n2. Partial Hydatidiform mole\\n3. Invasive mole\\n4. Choriocarcinoma\\nSelect correct answer:',correct:'1, 2, 3 and 4',options:['1, 2 and 3 only','2, 3 and 4 only','1, 2, 3 and 4','1 and 4 only'],exp:'GTD spectrum includes ALL four: Complete mole \u2714 (46,XX\/XY \u2014 entirely paternal; no fetal tissue; marked trophoblastic proliferation). Partial mole \u2714 (69,XXX\/XXY \u2014 triploid; some fetal tissue). Invasive mole \u2714 (GTN \u2014 mole invading myometrium; locally aggressive; chemo-sensitive). Choriocarcinoma \u2714 (GTN \u2014 highly malignant; no villi; haematogenous spread; very chemo-sensitive). Also in spectrum: PSTT, ETT. All four are part of GTD. Answer: 1, 2, 3 and 4.'},\n{id:51,stem:'Which of the following is NOT a component of Fothergill\\'s (Manchester) operation for uterovaginal prolapse?',correct:'Cervicopexy',options:['Amputation of cervix','Plication of Mackenrodt\\'s ligaments','Anterior colporrhaphy','Cervicopexy'],exp:'Fothergill\\'s\/Manchester operation components: Anterior colporrhaphy \u2714 (cystocele repair). Amputation of cervix (Sturmdorf) \u2714 (elongated cervix removed). Plication of Mackenrodt\\'s (cardinal\/transverse cervical) ligaments \u2714 (plicated in front of cervical stump for uterine support). Posterior colpoperineorrhaphy (usually added). CERVICOPEXY: suspension of the cervix to an abdominal\/sacral structure \u2014 a different procedure (sacrocolpopexy\/uterosacral suspension) NOT part of classical Fothergill operation. Answer: Cervicopexy.'},\n{id:52,stem:'Which one of the following statements is NOT true regarding physiological changes after delivery?',correct:'Cardiac output remains unchanged after delivery',options:['Pulse may be raised on first day','Temperature should not be above 99\u00b0F','Blood volume returns to normal by second week','Cardiac output remains unchanged after delivery'],exp:'Puerperal physiological changes: Pulse: slight rise day 1 is not abnormal (puerperal bradycardia is classic; mild tachycardia can occur) \u2714. Temperature: >100.4\u00b0F sustained = pathological; \u226499\u00b0F day 1\u20132 physiological \u2714. Blood volume: returns to normal over 3\u20136 weeks; approximately by 2nd week \u2714. CARDIAC OUTPUT: transiently INCREASES immediately postpartum (relief of aortocaval compression + uterine autotransfusion), then gradually decreases to pre-pregnancy levels over 2 weeks. It does NOT remain unchanged \u2014 major physiological change occurs. Answer: Cardiac output remains unchanged \u2014 NOT true.'},\n{id:53,stem:'Statements regarding Beta Thalassaemia in pregnancy:\\n1. There is low MCH and MCV\\n2. TIBC may be elevated or normal\\n3. HbA2 more than 3.5% on Haemoglobin Electrophoresis\\nWhich are correct?',correct:'1, 2 and 3',options:['1 only','1 and 2 only','2 and 3 only','1, 2 and 3'],exp:'Beta thalassaemia trait in pregnancy: (1) Low MCV (<75 fL) and MCH (<27 pg) \u2714 \u2014 microcytic hypochromic picture from reduced beta chain synthesis. (2) TIBC normal or mildly elevated \u2714 \u2014 iron stores adequate\/elevated (not iron deficiency); serum iron and ferritin normal\/elevated. (3) HbA2 >3.5% on electrophoresis \u2714 \u2014 PATHOGNOMONIC of beta thalassaemia trait (normal <3.5%; trait = 4\u20138%). Key diagnostic test. All three statements are correct. Answer: 1, 2 and 3.'},\n{id:54,stem:'A 20-year-old primigravida, 35 weeks, BP 170\/110 mmHg on 2 occasions, proteinuria. Which statement regarding management is NOT true?',correct:'Injection Dexamethasone is to be given for fetal lung maturity',options:['Can be labelled as Preeclampsia','Requires urgent admission','Injection Dexamethasone is to be given for fetal lung maturity','Both maternal and fetal monitoring are required'],exp:'Severe preeclampsia at 35 weeks: Can be labelled preeclampsia \u2714 (HTN + proteinuria after 20 weeks). Urgent admission \u2714 (severe PET is an emergency). Maternal + fetal monitoring \u2714 (BP, urine output, CTG, BPP). DEXAMETHASONE for lung maturity: indicated at 24\u201334 weeks. At 35 WEEKS, fetal lung maturity is generally adequate; antenatal corticosteroids are not routinely given. Some guidelines extend to 36+6 weeks for late preterm, but classical teaching = steroids <34 weeks. At 35 weeks severe PET, delivery is the treatment \u2014 dexamethasone for lung maturity is NOT routinely indicated. Answer: Dexamethasone for fetal lung maturity \u2014 NOT true at 35 weeks.'},\n{id:55,stem:'A 25-year-old G2P1, 2.5 months amenorrhoea, bleeding PV, pain abdomen. Cervical OS open, slight bleeding, uterus 10 weeks size, no fornix tenderness. Probable diagnosis:',correct:'Inevitable abortion',options:['Ectopic pregnancy','Incomplete abortion','Missed abortion','Inevitable abortion'],exp:'Analysis: OS OPEN + uterus size = dates (10 wks) + no products passed + no forniceal tenderness. INEVITABLE ABORTION \u2714 \u2014 OS open\/dilating, products not yet expelled, bleeding + cramping; abortion is unavoidable. Incomplete abortion: OS open + products PARTIALLY passed (tissue at OS\/history of passing tissue) \u2014 not described here. Missed abortion: fetal death, OS CLOSED, uterus smaller than dates. Ectopic: forniceal tenderness\/adnexal mass \u2014 absent here; uterus 10 wks excludes ectopic. OS open + 10-week uterus + no expelled tissue = INEVITABLE ABORTION. Answer: Inevitable abortion.'},\n{id:56,stem:'Which one of the following statements regarding intrauterine growth restriction is NOT correct?',correct:'Defined according to biparietal diameter',options:['Defined according to biparietal diameter','Doppler studies are indicated','There is danger of fetal asphyxia during delivery','Generally not seen in women with gestational diabetes'],exp:'IUGR facts: Doppler \u2714 \u2014 umbilical artery Doppler is key; absent\/reversed end-diastolic flow = severe compromise. Fetal asphyxia during delivery \u2714 \u2014 reduced placental reserve; uterine contractions \u2192 fetal distress. GDM: typically causes macrosomia (LGA), not IUGR \u2714 (broadly correct, though IUGR possible with severe vascular DM). DEFINITION: IUGR is defined as EFW or AC <10th percentile for gestational age \u2014 NOT by BPD alone. BPD-based definition is outdated. Current parameters = EFW (Hadlock formula) and AC. Answer: Defined by biparietal diameter \u2014 NOT correct.'},\n{id:57,stem:'A 15-year-old girl, 2 months amenorrhoea, positive urine pregnancy test, USS confirms 8-week pregnancy. Attendants not willing to file a police case. What should the treating doctor do?',correct:'Inform the police and make MLC',options:['Take consent for abortion and proceed','Inform the police and make MLC','Take parents consent for MTP','None of these'],exp:'A 15-year-old = minor. Pregnancy in a 15-year-old = STATUTORY RAPE under POCSO Act 2012 (any sexual act with a person <18 is an offence regardless of consent). MANDATORY REPORTING: Section 19 of POCSO mandates ANY person (including doctors) who knows of sexual abuse of a child to IMMEDIATELY report to police \u2014 failure is a criminal offence. Attendants\\' unwillingness is IRRELEVANT \u2014 the obligation is on the doctor, not the family. MLC registration is mandatory. Police reporting takes precedence before any MTP consideration. Answer: Inform the police and make MLC.'},\n{id:58,stem:'Which of the following is an absolute contraindication for use of oral contraceptive pills?',correct:'Focal Migraine',options:['Epilepsy','Smoking','Focal Migraine','Bronchial Asthma'],exp:'WHO MEC Category 4 (absolute contraindication) for COCs: FOCAL\/CLASSIC MIGRAINE WITH AURA \u2714 \u2014 oestrogen increases risk of ischaemic stroke; migraine with aura is a strong independent stroke risk factor; combination = WHO Category 4 = absolute contraindication. Also Cat 4: current breast cancer, DVT\/PE, IHD, stroke, liver tumours\/severe cirrhosis, SLE + antiphospholipid antibodies, smoking + age >35 + heavy. EPILEPSY: not a contraindication (enzyme-inducing AEDs reduce COC efficacy \u2014 use higher dose). SMOKING alone (without age >35): Category 2\u20133. BRONCHIAL ASTHMA: not a contraindication. Answer: Focal Migraine.'},\n{id:59,stem:'The amount of Ethinyl Estradiol in third generation combined oral contraceptive pills is:',correct:'20\u201330 mcg',options:['10\u201320 mcg','20\u201330 mcg','30\u201335 mcg','35\u201350 mcg'],exp:'OCP oestrogen content evolution: 1st generation: 50\u2013150 mcg EE. 2nd generation: 30\u201335 mcg EE + levonorgestrel\/norethisterone. 3rd GENERATION: 20\u201330 mcg EE + newer progestins (desogestrel, gestodene, norgestimate) \u2014 lower oestrogen, fewer oestrogenic side effects. Examples: Marvelon (EE 30 mcg + desogestrel 150 mcg), Mercilon (EE 20 mcg + desogestrel 150 mcg). 4th generation: 10\u201320 mcg (ultra-low dose). Third generation EE = 20\u201330 mcg. Answer: 20\u201330 mcg.'},\n{id:60,stem:'Which one of the following clinical situations is NOT ideal to perform female sterilisation?',correct:'7 days postpartum',options:['Postmenstrual period','7 days postpartum','Concurrent with MTP','3 months post abortion'],exp:'Ideal timing for tubectomy: Postmenstrual (interval) \u2714 \u2014 1\u20132 weeks after menstruation; uterus small, not pregnant. Concurrent with MTP \u2714 \u2014 simultaneous; one anaesthetic; uterus accessible. 3 months post abortion \u2714 \u2014 uterus returned to normal; safe interval sterilisation. NOT IDEAL \u2014 7 DAYS POSTPARTUM: best postpartum timing is within 48 hours (uterus large, infraumbilical approach easy) OR after 6 weeks. At 7 days: uterus is involuting, soft, highly vascular \u2192 high risk of haemorrhage and infection; technically very difficult. Answer: 7 days postpartum.'},\n{id:61,stem:'Cardiac diseases in pregnancy with major risk of maternal mortality:\\n1. Pulmonary hypertension\\n2. Aortic coarctation with valvular involvement\\n3. Atrial septal defect\\n4. Mitral stenosis\\nSelect correct answer:',correct:'1 and 2',options:['1 and 4','2 and 3','1 and 2','3 and 4'],exp:'WHO Category IV cardiac conditions in pregnancy (pregnancy contraindicated \u2014 major mortality risk): Pulmonary Arterial Hypertension (PAH) \u2714 \u2014 maternal mortality 30\u201356%; fixed pulmonary vascular resistance cannot accommodate pregnancy-related haemodynamic demands. Aortic coarctation with valvular involvement \u2714 \u2014 severe aortic disease + valvular pathology carries high risk (aortic dissection, fixed outflow obstruction). ATRIAL SEPTAL DEFECT: generally well-tolerated (low-pressure left-to-right shunt); NOT a major mortality risk (WHO Class II). MITRAL STENOSIS: moderate-severe MS has significant morbidity but usually WHO Class III not IV (unless critical). PAH and coarctation with valvular disease = highest mortality. Answer: 1 and 2.'},\n{id:62,stem:'Pregnancy can be terminated at any gestation if the fetus is diagnosed to have:',correct:'Anencephaly',options:['Duodenal atresia','Bilateral talipes','Anencephaly','Hydrocephalus'],exp:'MTP Act India: Standard limit 24 weeks (post-2021 amendment for certain categories). Beyond 24 weeks: termination permitted for LETHAL fetal conditions confirmed by Medical Board. ANENCEPHALY \u2714 \u2014 absence of cranial vault and brain; universally fatal (stillborn or dies within hours); 100% lethal. No treatment possible. Pregnancy can be terminated AT ANY GESTATION. Duodenal atresia: surgically correctable (associated with Down syndrome \u2014 not invariably lethal). Bilateral talipes: correctable orthopaedic condition. Hydrocephalus: severity varies; shunting possible. Anencephaly = invariably lethal = termination at any gestation permitted. Answer: Anencephaly.'},\n{id:63,stem:'Which one of the following is NOT a cause of recurrent spontaneous abortion?',correct:'Rubella infection',options:['Chromosomal abnormality','Antiphospholipid syndrome','Rubella infection','Inherited thrombophilia'],exp:'Recurrent Pregnancy Loss (RPL \u2014 3+ consecutive losses) causes: Chromosomal \u2714 \u2014 parental balanced translocations (2\u20135%); de novo embryo errors. Antiphospholipid syndrome \u2714 \u2014 most important treatable cause; anticardiolipin Ab\/lupus anticoagulant \u2192 placental thrombosis \u2192 recurrent losses (typically 2nd trimester). Inherited thrombophilia \u2714 \u2014 Factor V Leiden, prothrombin G20210A, protein C\/S deficiency. Also: uterine anomalies (septum), cervical incompetence, endocrine causes, unexplained. RUBELLA: acute infection causes congenital rubella syndrome in 1st trimester \u2014 NOT a cause of RECURRENT abortion (immunity develops after single infection; not a recurring risk). Answer: Rubella infection.'},\n{id:64,stem:'The congenital abnormality which is invariably lethal:\\n1. Anencephaly\\n2. Transposition of great vessels\\n3. Down Syndrome\\nSelect correct answer:',correct:'1 only',options:['1 only','1 and 3','1 and 2','2 and 3'],exp:'ANENCEPHALY \u2714 \u2014 100% lethal; absence of cranial vault and brain; stillborn or dies within hours\/days; no treatment possible. TRANSPOSITION OF GREAT VESSELS (TGA): potentially lethal without treatment BUT arterial switch operation (Jatene) achieves >95% survival. NOT invariably lethal with modern surgery. DOWN SYNDROME (Trisomy 21): NOT lethal \u2014 life expectancy 60\u201370 years with support; good quality of life possible. Only Anencephaly is universally and invariably lethal. Answer: 1 only.'},\n{id:65,stem:'For vaginal breech delivery, ideal selection criteria include:\\n1. Fetus not compromised\\n2. Adequate pelvis\\n3. Extended breech presentation\\n4. Estimated fetal weight < 3.5 kg\\nSelect correct answer:',correct:'1, 2, 3 and 4',options:['1, 2 and 3 only','1, 2, 3 and 4','1, 3 and 4 only','2 and 4 only'],exp:'Criteria for vaginal breech delivery (selected cases): (1) Fetus not compromised \u2714 \u2014 no fetal distress; reassuring CTG. (2) Adequate pelvis \u2714 \u2014 clinical\/radiological pelvimetry confirming no contracted pelvis. (3) Extended (frank) breech \u2714 \u2014 hips flexed, knees extended; most favourable position; footling breech contraindicated (cord prolapse risk). (4) EFW <3.5 kg \u2714 \u2014 safe fetal size; macrosomia increases risk of head entrapment. Also required: experienced obstetrician, singleton, 37\u201342 weeks, no placenta praevia. All four are valid selection criteria. Answer: 1, 2, 3 and 4.'},\n{id:66,stem:'In which of the following presentations is vaginal delivery NOT possible?\\n1. Brow presentation\\n2. Left mento anterior position\\n3. Occipito posterior position\\n4. Breech presentation',correct:'1 only',options:['1, 2 and 3','1 and 3 only','1 only','4 only'],exp:'BROW PRESENTATION \u2714 NOT possible \u2014 mentovertical diameter ~13.5 cm (largest); cannot engage in normal pelvis. Persistent brow = CS unless converts to face (extension) or vertex (flexion). LEFT MENTO ANTERIOR (face, chin anterior) \u2714 POSSIBLE \u2014 chin anterior; neck extends under pubic arch; vaginal delivery feasible. MENTO POSTERIOR = NOT possible. OCCIPITO POSTERIOR \u2714 POSSIBLE \u2014 most rotate to OA spontaneously; persistent OP can deliver vaginally (\"face to pubes\"). BREECH \u2714 POSSIBLE \u2014 in carefully selected cases. Only BROW = vaginal delivery impossible. Answer: 1 only.'},\n{id:67,stem:'The blood supply of the uterus is from:\\n1. Uterine artery\\n2. Ovarian artery\\n3. Pudendal artery\\n4. Superior vesical artery\\nSelect correct answer:',correct:'1 and 2',options:['1 and 2','2 and 4','1 and 3','3 and 4'],exp:'Uterine blood supply: PRIMARY \u2014 UTERINE ARTERY \u2714 (branch of internal iliac anterior division; crosses ureter at internal os \u2014 \"water under the bridge\"; supplies most of uterus). SECONDARY \u2014 OVARIAN ARTERY \u2714 (branch of aorta; descends in infundibulopelvic ligament; anastomoses with uterine artery in broad ligament; supplies fundus). Pudendal artery: supplies perineum, clitoris, labia, lower vagina \u2014 NOT uterus. Superior vesical artery: supplies bladder \u2014 NOT uterus. Rich uterine-ovarian anastomosis explains why bilateral uterine artery ligation may fail. Answer: 1 and 2.'},\n{id:68,stem:'Which one of the following regarding amniotic fluid is true?',correct:'It reveals information about fetal lung maturity and wellbeing',options:['The volume is highest at 28 weeks','It reveals information about fetal lung maturity and wellbeing','It is decreased in duodenal atresia in baby','It is decreased in gestational diabetes'],exp:'Amniotic fluid facts: Volume peaks at 34\u201336 weeks (~800\u20131000 mL) \u2014 NOT at 28 weeks (still increasing). Duodenal atresia \u2192 POLYHYDRAMNIOS (cannot swallow \u2192 fluid accumulates) \u2014 NOT decreased. Gestational diabetes \u2192 POLYHYDRAMNIOS (fetal hyperglycaemia \u2192 polyuria \u2192 increased AF) \u2014 NOT decreased. REVEALS INFORMATION \u2714 \u2014 amniocentesis provides: L\/S ratio >2.0 = fetal lung maturity, phosphatidylglycerol (lung maturity), bilirubin OD450 (haemolytic disease), karyotype, AFP, fetal wellbeing assessment. Answer: It reveals information about fetal lung maturity and wellbeing.'},\n{id:69,stem:'Statements regarding changes in pregnancy:\\n1. Plasma volume increases up to 30\u201350%\\n2. Pregnancy is a hypercoagulable state\\n3. Haematocrit is decreased\\n4. Total plasma proteins increases\\nWhich are correct?',correct:'1, 2 and 3',options:['1 only','1, 2, 3 and 4','1 and 2 only','1, 2 and 3'],exp:'(1) Plasma volume \u2714 increases 40\u201350% (peaks 28\u201334 wks). (2) Hypercoagulable \u2714 \u2014 factors I (fibrinogen), VII, VIII, IX, X, XII \u2191; protein S \u2193; fibrinolysis impaired \u2192 protects from PPH but increases VTE risk. (3) Haematocrit DECREASES \u2714 \u2014 haemodilution (plasma \u2191 > RBC \u2191) \u2192 physiological anaemia of pregnancy. (4) Total plasma proteins: albumin DECREASES (dilution effect); total plasma protein concentration generally decreases. Fibrinogen increases but is classified separately. Per standard teaching: protein concentration decreases in pregnancy. Statements 1, 2, 3 are correct; statement 4 is not universally correct. Answer: 1, 2 and 3.'},\n{id:70,stem:'Which one of the following statements regarding anatomy of fetal head is NOT true?',correct:'Lambdoid suture separates the two parietal bones',options:['Coronal suture separates frontal bones from parietal bones','Lambdoid suture separates the two parietal bones','Frontal suture separates the two frontal bones','Bregma is a diamond shaped space at junction of coronal and sagittal sutures'],exp:'Fetal skull sutures: Coronal suture \u2714 \u2014 separates FRONTAL from PARIETAL bones (transverse). Frontal suture \u2714 \u2014 separates the TWO FRONTAL BONES (midline anterior). Bregma (anterior fontanelle) \u2714 \u2014 diamond-shaped; junction of coronal + frontal + sagittal sutures. LAMBDOID SUTURE: separates the TWO PARIETAL BONES from the OCCIPITAL BONE \u2014 NOT between the two parietals. The SAGITTAL SUTURE separates the two parietal bones from each other (midline, front to back). \"Lambdoid separates the two parietal bones\" is FALSE. Answer: Lambdoid suture separates the two parietal bones.'},\n{id:71,stem:'A 30-year-old, mother of 3, stage 3 prolapse, moderate cystocele, no posterior vaginal wall prolapse. Recommended surgery:\\n1. Cystocele repair\\n2. Rectocele repair\\n3. Manchester operation\\n4. Vaginal hysterectomy\\nSelect correct answer:',correct:'1, 2 and 4',options:['1 and 3 only','1, 2 and 3','3 only','1, 2 and 4'],exp:'Stage 3 uterovaginal prolapse + moderate cystocele, family complete (3 children): VAGINAL HYSTERECTOMY \u2714 \u2014 definitive treatment for significant uterovaginal prolapse. CYSTOCELE REPAIR (anterior colporrhaphy) \u2714 \u2014 for the moderate cystocele. Posterior colpoperineorrhaphy (rectocele repair) \u2014 conventionally performed as part of repair suite; standard answer includes it. MANCHESTER OPERATION \u2014 for cervical elongation with lesser degrees of prolapse when uterus preservation desired; at Stage 3 in a multiparous woman, vaginal hysterectomy preferred. Standard UPSC answer for this scenario: 1, 2 and 4 (vaginal hysterectomy + cystocele repair + posterior repair as combined vault repair). Answer: 1, 2 and 4.'},\n{id:72,stem:'A 50-year-old post-menopausal woman with bleeding per vaginum. Which investigation is NOT required?',correct:'Diagnostic laparoscopy',options:['Endometrial biopsy','Diagnostic laparoscopy','Hysteroscopy','Pap smear'],exp:'Post-menopausal bleeding (PMB) workup: Endometrial biopsy \u2714 \u2014 essential; rules out endometrial carcinoma (most common cause). Pipelle\/D&C biopsy. Hysteroscopy \u2714 \u2014 gold standard; visualises uterine cavity; directed biopsy; detects polyps, fibroids, carcinoma. Pap smear \u2714 \u2014 excludes cervical carcinoma. TVS \u2014 endometrial thickness (>4 mm = suspicious). DIAGNOSTIC LAPAROSCOPY: evaluates PERITONEAL CAVITY and external pelvic organs \u2014 has no role in evaluating endometrial\/cervical causes of PMB (which are intrauterine\/intraluminal). Laparoscopy sees OUTSIDE the uterus, not the endometrium. NOT required for routine PMB evaluation. Answer: Diagnostic laparoscopy.'},\n{id:73,stem:'Statements regarding \u03b2-hCG that are NOT correct:\\n1. It is a glycoprotein hormone\\n2. Serum levels increase in pregnancy, germ cell tumour and GTD\\n3. Its levels are same in single and multiple pregnancy\\n4. It has common Alpha-subunit with FSH, LH and TSH\\nSelect the NOT correct statements:',correct:'3 only',options:['1, 2 and 4','1, 2 and 3','2, 3 and 4','3 only'],exp:'\u03b2-hCG analysis: (1) Glycoprotein \u2714 TRUE \u2014 alpha + beta subunits, both glycosylated. (2) Levels increase in pregnancy, germ cell tumours, GTD \u2714 TRUE. (3) Levels same in single and multiple pregnancy: NOT CORRECT \u2714 \u2014 levels are HIGHER in multiple pregnancy (more trophoblastic tissue); also higher in molar pregnancy. (4) Common alpha-subunit with FSH, LH, TSH \u2714 TRUE \u2014 all four pituitary\/placental glycoproteins share identical alpha subunit; beta subunit confers specificity. Only statement 3 is NOT correct. Per UPSC answer key convention: Answer: 3 only.'},\n{id:74,stem:'Which one of the following is NOT an emergency contraception method?',correct:'Norplant',options:['Levonorgestrel','Norplant','Intra uterine contraceptive device','High dose oral contraceptive pill'],exp:'Emergency contraception methods: Levonorgestrel \u2714 (1.5 mg single dose or 0.75 mg \u00d7 2 within 72 hours \u2014 most widely used EC). High-dose OCP \u2714 (Yuzpe method: EE 100 mcg + LNG 0.5 mg \u00d7 2 doses, 12h apart, within 72h). Copper IUCD \u2714 (most effective EC >99%; inserted within 5 days). Also: mifepristone (low dose). NORPLANT: subdermal implant (6 LNG rods) \u2014 provides 5 years of ONGOING regular contraception; cannot be inserted as emergency post-coital contraception. NOT an emergency contraceptive. Answer: Norplant.'},\n{id:75,stem:'All of the following statements are correct about vasectomy EXCEPT:',correct:'It increases the incidence of testicular cancer',options:['No Scalpel Vasectomy was first developed in China','It increases the incidence of testicular cancer','It is less time consuming than tubectomy','Additional contraception should be used for 3 months after vasectomy'],exp:'Vasectomy facts: NSV first developed in China \u2714 (Dr Li Shunqiang, 1974; now global standard). Less time consuming than tubectomy \u2714 (10\u201320 min, local anaesthesia vs general\/regional for tubectomy). Additional contraception for 3 months \u2714 (residual sperms; confirm azoospermia after ~20 ejaculations). TESTICULAR CANCER: large prospective studies conclusively show NO increased risk of testicular cancer with vasectomy. Earlier studies had methodological flaws; this has been refuted. Vasectomy does NOT increase testicular cancer risk. Answer: It increases testicular cancer incidence \u2014 NOT correct.'},\n{id:76,stem:'Which statement regarding anaemia in pregnancy is NOT true?',correct:'If mother is severely anaemic, the fetus is also severely anaemic',options:['Iron deficiency anaemia is most common in Tropics','Faulty dietary habit is one of the factors responsible','Mild anaemia is most common','If mother is severely anaemic, the fetus is also severely anaemic'],exp:'Anaemia in pregnancy: Iron deficiency most common in tropics \u2714 (~75% of anaemia in pregnancy in developing countries). Faulty dietary habits \u2714 \u2014 inadequate iron\/folate; phytates reduce iron absorption. Mild anaemia most common \u2714 (Hb 9\u201311 g\/dL is mild; severe = Hb <7 g\/dL). FETAL ANAEMIA: the fetus has PRIORITY access to maternal iron via active transport across the placenta \u2014 even in severe maternal anaemia, the fetus maintains near-normal haemoglobin levels (fetal Hb is NOT proportionately low). \"If mother is severely anaemic, fetus is also severely anaemic\" is NOT TRUE. The placenta actively transports iron to the fetus preferentially. Answer: If mother severely anaemic, fetus also severely anaemic \u2014 NOT true.'},\n{id:77,stem:'Which one of the following statements about male sterilisation is NOT true?',correct:'It is performed under general anaesthesia',options:['It is safer and less expensive','Most men develop antisperm antibodies','It has a low failure rate','It is performed under general anaesthesia'],exp:'Male sterilisation (vasectomy) facts: Safer and less expensive \u2714 \u2014 compared to tubectomy; outpatient procedure, local anaesthesia, fewer complications. Antisperm antibodies \u2714 \u2014 majority of men (~70%) develop antisperm antibodies post-vasectomy; clinically significant in reversal attempts. Low failure rate \u2714 \u2014 failure rate ~0.1% (among the most effective reversible or permanent contraceptive methods). GENERAL ANAESTHESIA: vasectomy is performed under LOCAL ANAESTHESIA \u2014 NOT general anaesthesia. This is one of its major advantages over tubectomy (which may require general\/regional). Answer: Performed under general anaesthesia \u2014 NOT true.'},\n{id:78,stem:'Which of the following is NOT a method of second trimester abortion?',correct:'Mifepristone and PGE1',options:['Mifepristone and PGE1','PGE2 analog','Intra-amniotic KCl instillation','Hysterotomy'],exp:'Second trimester abortion (13\u201324 weeks) methods: PGE2 analogue \u2714 (dinoprostone \u2014 vaginal, extra-amniotic instillation \u2014 valid 2nd trimester method). Intra-amniotic KCl instillation \u2714 (feticide \u2014 used in selective fetal reduction and late termination; potassium chloride injected into fetal heart under USS guidance). Hysterotomy \u2714 (surgical \u2014 mini-laparotomy; rarely used but valid for 2nd trimester). MIFEPRISTONE + PGE1 (misoprostol): Mifepristone 200 mg + misoprostol is the standard FIRST TRIMESTER medical abortion regimen (up to 10\u201312 weeks). While misoprostol alone can be used in 2nd trimester, the combination of mifepristone + PGE1 is primarily a 1st trimester regimen. For 2nd trimester, PGE2 or extra-amniotic methods are used. Answer: Mifepristone and PGE1 \u2014 NOT a 2nd trimester method.'},\n{id:79,stem:'During MTP by suction and evacuation, perforation of uterus occurred with cannula. The next step should be:',correct:'Laparotomy with exploration of bowel',options:['Laparotomy with exploration of bowel','Manual vacuum aspiration','Wait and watch','Complete the evacuation with curette'],exp:'Uterine perforation during MTP: Perforation by a CANNULA (suction) is a potentially serious complication. Management depends on the instrument and suspected damage: Perforation by a blunt instrument (dilator) in a stable patient: may watch closely. Perforation by SHARP\/SUCTION INSTRUMENT (cannula): HIGH RISK of bowel injury \u2014 the suction cannula may have aspirated bowel. IMMEDIATE LAPAROTOMY is required to: (1) Inspect and repair the uterine perforation. (2) EXPLORE THE BOWEL for inadvertent bowel injury (which, if missed, causes peritonitis and sepsis). Continuing evacuation risks further bowel aspiration. Wait and watch is dangerous. MVA will not address the bowel injury. Answer: Laparotomy with exploration of bowel.'},\n{id:80,stem:'Statements regarding MTP (Medical Termination of Pregnancy):\\n1. Suction and evacuation can be done up till 12 weeks\\n2. Medical methods can be used up till 10 weeks\\n3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks\\nWhich are correct?',correct:'1 only',options:['1 only','2 and 3','2 only','1 and 3'],exp:'MTP methods and gestational limits: (1) Suction and evacuation (electric vacuum aspiration \/ sharp curettage) up to 12 weeks \u2714 \u2014 standard first-trimester surgical method; widely used up to 12 weeks gestation. (2) Medical methods (mifepristone + misoprostol) up to 10 weeks: PARTIALLY correct \u2014 MTP Act 2021 and WHO guidelines support medical abortion up to 9\u201310 weeks (some protocols up to 12 weeks with higher misoprostol doses). But the standard Indian MTP teaching = up to 9 weeks (not 10). Statement 2 is approximately correct but 9 weeks is the standard cut-off in many references. (3) MVA up to 6 weeks: INCORRECT \u2014 MVA can be used up to 12 weeks (same as EVA\/surgical); the double-valve MVA syringe is effective up to 10\u201312 weeks. Not limited to 6 weeks. Per standard UPSC answer: Statement 1 only is unambiguously correct. 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id=\"cms18p2b-ti\">\u23f1 <strong id=\"cms18p2b-td\">40:00<\/strong><\/div>\n <div class=\"si\">\u2705 <strong id=\"cms18p2b-sc\">0<\/strong><\/div>\n <div class=\"si\">\u274c <strong id=\"cms18p2b-sw\">0<\/strong><\/div>\n <div class=\"si\">\u23f3 <strong id=\"cms18p2b-sr\">40<\/strong> left<\/div>\n <div class=\"ss\"><\/div>\n <div class=\"si\">Net <strong id=\"cms18p2b-sn\">0<\/strong> \/ <strong id=\"cms18p2b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"sp\"><div class=\"sf\" id=\"cms18p2b-sf\"><\/div><\/div>\n<\/div>\n<div class=\"gr\" id=\"cms18p2b-gr\">\n <div class=\"gb\"><h3>Time's Up!<\/h3><p>Submitting in<\/p><div class=\"gc\" id=\"cms18p2b-gc\">10<\/div><button class=\"gn\" id=\"cms18p2b-gn\">Submit Now<\/button><\/div>\n<\/div>\n<div class=\"hd\">\n <h1>Combined Medical Services Examination 2018<br>Paper II \u00b7 Part B<\/h1>\n <p>Obstetrics & Gynaecology<\/p>\n <div class=\"mt\">\n <span class=\"bd\">Questions 41 \u2013 80<\/span>\n <span class=\"bd\">Options reshuffled<\/span>\n <button class=\"tb\" id=\"cms18p2b-tb\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"bd2\">\n <div id=\"cms18p2b-qs\"><\/div>\n <div class=\"sw\"><button class=\"bt\" id=\"cms18p2b-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms18p2b-sc-box\">\n <div class=\"rg\" id=\"cms18p2b-rg\"><div class=\"ri\"><span class=\"rp\" id=\"cms18p2b-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms18p2b-nl\"><\/div>\n <div class=\"vd\" id=\"cms18p2b-vd\"><\/div>\n <div class=\"bs\"><span class=\"bn bc\" id=\"cms18p2b-bc\"><\/span><span class=\"bn bw\" id=\"cms18p2b-bw\"><\/span><span class=\"bn bk\" id=\"cms18p2b-bk\"><\/span><\/div>\n <button class=\"rb\" id=\"cms18p2b-rb\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms18p2b',TOTAL=40,MAX=160,TSECS=2400,GSECS=10;\nvar QS=[\n{id:41,stem:'Consider haemodynamic changes during pregnancy:\\n1. Increase in cardiac output\\n2. Increase in stroke volume\\n3. Increase in colloid oncotic pressure\\n4. Increase in pulse rate\\nWhich are correct?',correct:'1, 2 and 4',options:['1, 3 and 4','1, 2 and 4','1, 2 and 3','2, 3 and 4'],exp:'Cardiac output \u2191 (30\u201350%, peaks 28\u201332 wks). Stroke volume \u2191 (~30% \u2014 increased preload, reduced afterload). Pulse rate \u2191 (10\u201315 bpm above baseline). Colloid oncotic pressure: DECREASES \u2014 albumin is diluted by expanded plasma volume \u2192 lower oncotic pressure \u2192 predisposes to oedema. Statement 3 is FALSE. Correct: 1, 2 and 4.'},\n{id:42,stem:'Which of the following are hypotheses for onset of Labour?\\n1. Uterine distension\\n2. Activation of fetal HPA axis\\n3. Increase in prostaglandins\\n4. Increase in serum calcium levels\\nSelect correct answer:',correct:'1, 2 and 3',options:['1, 2 and 3','1, 2 and 4','1 and 3 only','2, 3 and 4'],exp:'Uterine distension \u2714 \u2014 stretching activates prostaglandin release and gap junctions. Fetal HPA axis activation \u2714 \u2014 fetal cortisol drives oestrogen synthesis, shifts E:P ratio, upregulates oxytocin receptors. Prostaglandins (PGE2, PGF2\u03b1) \u2714 \u2014 ripen cervix, stimulate contractions. Serum calcium: NOT a recognised hypothesis for labour onset; calcium mediates intracellular contraction but rising serum Ca is not a trigger. Statement 4 FALSE. Correct: 1, 2 and 3.'},\n{id:43,stem:'Which statements regarding Puerperal sepsis are correct?\\n1. Multiple PV examinations increase the risk\\n2. Responsible organisms are Group A and B beta-haemolytic Streptococcus\\n3. Retained bits of placenta and membrane predispose\\n4. Vaginal packing can decrease the risk\\nSelect correct answer:',correct:'1, 2 and 3',options:['1, 2 and 3','2, 3 and 4','1, 3 and 4','1, 2 and 4'],exp:'(1) Multiple PV exams \u2714 \u2014 each exam introduces vaginal flora into the uterine cavity; key preventable cause of puerperal sepsis. (2) Group A beta-haemolytic Streptococcus \u2714 (classic \u2014 Semmelweis; S. pyogenes); Group B Strep also implicated. (3) Retained placental\/membrane fragments \u2714 \u2014 nidus for bacterial growth, predispose to endometritis. (4) Vaginal packing does NOT decrease risk \u2014 retained packs are a risk factor for infection. Statement 4 FALSE. Correct: 1, 2 and 3.'},\n{id:44,stem:'In labour complicated with cord prolapse, which statements are correct?\\n1. Reposition patient in exaggerated Sims position\\n2. Replace the cord in the vagina\\n3. Replace the cord inside the uterus\\n4. Early amniotomy can prevent cord prolapse\\nSelect correct answer:',correct:'1 and 2 only',options:['1, 2, 3 and 4','1 and 2 only','1, 2 and 3 only','3 and 4 only'],exp:'(1) Exaggerated Sims or knee-chest position \u2714 \u2014 gravity relieves cord compression. (2) Replace cord IN THE VAGINA \u2714 \u2014 kept warm and moist; minimise handling to prevent spasm; do NOT leave outside. (3) Replace cord INSIDE uterus \u2014 NOT recommended; attempted funic reduction risks trauma and is not standard practice. (4) Early amniotomy INCREASES cord prolapse risk (intact membranes cushion the cord; ARM before engagement is dangerous). Statements 3 and 4 FALSE. Correct: 1 and 2 only.'},\n{id:45,stem:'The following are contents of the broad ligament EXCEPT:',correct:'Internal iliac artery',options:['Fallopian tube','Uterine and ovarian arteries with their branches','Ovarian ligament','Internal iliac artery'],exp:'Broad ligament contents: Fallopian tube \u2714 (mesosalpinx \u2014 upper free edge), Uterine artery branches \u2714 (crosses ureter \u2014 \"water under the bridge\"), Ovarian artery branches \u2714 (in mesovarium), Ovarian ligament \u2714 (connects ovary to uterus), Round ligament, ureter, lymphatics, parametrial tissue. INTERNAL ILIAC ARTERY: runs on the lateral pelvic wall \u2014 NOT contained within the broad ligament. The uterine artery arises from it and enters the broad ligament; the internal iliac itself remains on the pelvic sidewall. Answer: Internal iliac artery.'},\n{id:46,stem:'Which one of the following is true regarding normal menstrual physiology?',correct:'Threshold of LH surge generally persists for 48 hours',options:['Ovulation occurs after 48 hours of LH surge','Oestradiol levels peak at 48 hours prior to ovulation','Ovulation occurs after 12 hours of LH peak','Threshold of LH surge generally persists for 48 hours'],exp:'LH surge: initiated by oestradiol peak (which precedes surge by 24\u201336 h); threshold of LH surge persists ~48 hours \u2714 \u2014 standard textbook statement. Ovulation: occurs 34\u201338 h after ONSET of LH surge, or 10\u201312 h after LH PEAK (option c says 12 h after LH peak \u2014 approximately correct, but the 48-hour persistence is the more standard textbook statement). Oestradiol peaks ~24\u201336 h BEFORE ovulation (not exactly 48 h before). The most precisely correct statement among the options: \"Threshold of LH surge persists for 48 hours.\" Answer: Threshold of LH surge persists for 48 hours.'},\n{id:47,stem:'Which one of the following is NOT a feature of Candida Vaginitis?',correct:'Metronidazole is the treatment of choice',options:['Pruritus is out of proportion to discharge','Discharge is thick and curdy','Yeast-buds and pseudohyphae can be seen under microscope','Metronidazole is the treatment of choice'],exp:'Candida vaginitis (Candida albicans): Pruritus \u2714 \u2014 intense vulval itching, out of proportion to discharge. Discharge \u2714 \u2014 thick, white, curdy\/cottage-cheese, non-offensive. Microscopy \u2714 \u2014 KOH prep shows budding yeast (blastospores) and pseudohyphae. pH normal (<4.5). Treatment: FLUCONAZOLE (oral 150 mg single dose) or topical azoles (clotrimazole, miconazole). METRONIDAZOLE: treats Bacterial Vaginosis (Gardnerella) and Trichomonas \u2014 NO activity against Candida (a fungus). Answer: Metronidazole is the treatment \u2014 NOT a feature.'},\n{id:48,stem:'Which of the following is NOT a high risk factor for developing endometrial carcinoma?',correct:'Multiparity',options:['Delayed menopause','Hypertension','Multiparity','Obesity'],exp:'Risk factors for Type I endometrial carcinoma (oestrogen-dependent): Obesity \u2714 (peripheral aromatisation in adipose tissue), Delayed menopause \u2714 (prolonged oestrogen exposure), Hypertension \u2714 (part of metabolic syndrome \u2014 obesity-HTN-DM cluster), Nulliparity, PCOS, Diabetes, Tamoxifen. MULTIPARITY: PROTECTIVE \u2014 each full-term pregnancy provides a progestin-dominant phase (corpus luteum progesterone) counterbalancing oestrogen. Multiparous women have LOWER risk. Nulliparity = risk; Multiparity = protective. Answer: Multiparity \u2014 NOT a high risk factor.'},\n{id:49,stem:'All of the following are features of functional ovarian cyst EXCEPT:',correct:'Usually symptomatic',options:['Usually < 7 cm in diameter','Spontaneous regression occurs','Unilocular','Usually symptomatic'],exp:'Functional ovarian cysts (follicular, corpus luteum, theca-lutein): <7 cm \u2714 (follicular rarely >8 cm). Spontaneous regression \u2714 \u2014 hallmark; most resolve within 1\u20133 menstrual cycles. Unilocular \u2714 \u2014 thin-walled, simple, no internal echoes on USS. SYMPTOMS: functional cysts are typically ASYMPTOMATIC \u2014 incidental USS findings. They are NOT usually symptomatic; symptoms arise only from complications (torsion, rupture, haemorrhage). \"Usually symptomatic\" = NOT a feature. Answer: Usually symptomatic.'},\n{id:50,stem:'Gestational trophoblastic disease spectrum comprises:\\n1. Complete Hydatidiform mole\\n2. Partial Hydatidiform mole\\n3. Invasive mole\\n4. Choriocarcinoma\\nSelect correct answer:',correct:'1, 2, 3 and 4',options:['1, 2 and 3 only','2, 3 and 4 only','1, 2, 3 and 4','1 and 4 only'],exp:'GTD spectrum includes ALL four: Complete mole \u2714 (46,XX\/XY \u2014 entirely paternal; no fetal tissue; marked trophoblastic proliferation). Partial mole \u2714 (69,XXX\/XXY \u2014 triploid; some fetal tissue). Invasive mole \u2714 (GTN \u2014 mole invading myometrium; locally aggressive; chemo-sensitive). Choriocarcinoma \u2714 (GTN \u2014 highly malignant; no villi; haematogenous spread; very chemo-sensitive). Also in spectrum: PSTT, ETT. All four are part of GTD. Answer: 1, 2, 3 and 4.'},\n{id:51,stem:'Which of the following is NOT a component of Fothergill\\'s (Manchester) operation for uterovaginal prolapse?',correct:'Cervicopexy',options:['Amputation of cervix','Plication of Mackenrodt\\'s ligaments','Anterior colporrhaphy','Cervicopexy'],exp:'Fothergill\\'s\/Manchester operation components: Anterior colporrhaphy \u2714 (cystocele repair). Amputation of cervix (Sturmdorf) \u2714 (elongated cervix removed). Plication of Mackenrodt\\'s (cardinal\/transverse cervical) ligaments \u2714 (plicated in front of cervical stump for uterine support). Posterior colpoperineorrhaphy (usually added). CERVICOPEXY: suspension of the cervix to an abdominal\/sacral structure \u2014 a different procedure (sacrocolpopexy\/uterosacral suspension) NOT part of classical Fothergill operation. Answer: Cervicopexy.'},\n{id:52,stem:'Which one of the following statements is NOT true regarding physiological changes after delivery?',correct:'Cardiac output remains unchanged after delivery',options:['Pulse may be raised on first day','Temperature should not be above 99\u00b0F','Blood volume returns to normal by second week','Cardiac output remains unchanged after delivery'],exp:'Puerperal physiological changes: Pulse: slight rise day 1 is not abnormal (puerperal bradycardia is classic; mild tachycardia can occur) \u2714. Temperature: >100.4\u00b0F sustained = pathological; \u226499\u00b0F day 1\u20132 physiological \u2714. Blood volume: returns to normal over 3\u20136 weeks; approximately by 2nd week \u2714. CARDIAC OUTPUT: transiently INCREASES immediately postpartum (relief of aortocaval compression + uterine autotransfusion), then gradually decreases to pre-pregnancy levels over 2 weeks. It does NOT remain unchanged \u2014 major physiological change occurs. Answer: Cardiac output remains unchanged \u2014 NOT true.'},\n{id:53,stem:'Statements regarding Beta Thalassaemia in pregnancy:\\n1. There is low MCH and MCV\\n2. TIBC may be elevated or normal\\n3. HbA2 more than 3.5% on Haemoglobin Electrophoresis\\nWhich are correct?',correct:'1, 2 and 3',options:['1 only','1 and 2 only','2 and 3 only','1, 2 and 3'],exp:'Beta thalassaemia trait in pregnancy: (1) Low MCV (<75 fL) and MCH (<27 pg) \u2714 \u2014 microcytic hypochromic picture from reduced beta chain synthesis. (2) TIBC normal or mildly elevated \u2714 \u2014 iron stores adequate\/elevated (not iron deficiency); serum iron and ferritin normal\/elevated. (3) HbA2 >3.5% on electrophoresis \u2714 \u2014 PATHOGNOMONIC of beta thalassaemia trait (normal <3.5%; trait = 4\u20138%). Key diagnostic test. All three statements are correct. Answer: 1, 2 and 3.'},\n{id:54,stem:'A 20-year-old primigravida, 35 weeks, BP 170\/110 mmHg on 2 occasions, proteinuria. Which statement regarding management is NOT true?',correct:'Injection Dexamethasone is to be given for fetal lung maturity',options:['Can be labelled as Preeclampsia','Requires urgent admission','Injection Dexamethasone is to be given for fetal lung maturity','Both maternal and fetal monitoring are required'],exp:'Severe preeclampsia at 35 weeks: Can be labelled preeclampsia \u2714 (HTN + proteinuria after 20 weeks). Urgent admission \u2714 (severe PET is an emergency). Maternal + fetal monitoring \u2714 (BP, urine output, CTG, BPP). DEXAMETHASONE for lung maturity: indicated at 24\u201334 weeks. At 35 WEEKS, fetal lung maturity is generally adequate; antenatal corticosteroids are not routinely given. Some guidelines extend to 36+6 weeks for late preterm, but classical teaching = steroids <34 weeks. At 35 weeks severe PET, delivery is the treatment \u2014 dexamethasone for lung maturity is NOT routinely indicated. Answer: Dexamethasone for fetal lung maturity \u2014 NOT true at 35 weeks.'},\n{id:55,stem:'A 25-year-old G2P1, 2.5 months amenorrhoea, bleeding PV, pain abdomen. Cervical OS open, slight bleeding, uterus 10 weeks size, no fornix tenderness. Probable diagnosis:',correct:'Inevitable abortion',options:['Ectopic pregnancy','Incomplete abortion','Missed abortion','Inevitable abortion'],exp:'Analysis: OS OPEN + uterus size = dates (10 wks) + no products passed + no forniceal tenderness. INEVITABLE ABORTION \u2714 \u2014 OS open\/dilating, products not yet expelled, bleeding + cramping; abortion is unavoidable. Incomplete abortion: OS open + products PARTIALLY passed (tissue at OS\/history of passing tissue) \u2014 not described here. Missed abortion: fetal death, OS CLOSED, uterus smaller than dates. Ectopic: forniceal tenderness\/adnexal mass \u2014 absent here; uterus 10 wks excludes ectopic. OS open + 10-week uterus + no expelled tissue = INEVITABLE ABORTION. Answer: Inevitable abortion.'},\n{id:56,stem:'Which one of the following statements regarding intrauterine growth restriction is NOT correct?',correct:'Defined according to biparietal diameter',options:['Defined according to biparietal diameter','Doppler studies are indicated','There is danger of fetal asphyxia during delivery','Generally not seen in women with gestational diabetes'],exp:'IUGR facts: Doppler \u2714 \u2014 umbilical artery Doppler is key; absent\/reversed end-diastolic flow = severe compromise. Fetal asphyxia during delivery \u2714 \u2014 reduced placental reserve; uterine contractions \u2192 fetal distress. GDM: typically causes macrosomia (LGA), not IUGR \u2714 (broadly correct, though IUGR possible with severe vascular DM). DEFINITION: IUGR is defined as EFW or AC <10th percentile for gestational age \u2014 NOT by BPD alone. BPD-based definition is outdated. Current parameters = EFW (Hadlock formula) and AC. Answer: Defined by biparietal diameter \u2014 NOT correct.'},\n{id:57,stem:'A 15-year-old girl, 2 months amenorrhoea, positive urine pregnancy test, USS confirms 8-week pregnancy. Attendants not willing to file a police case. What should the treating doctor do?',correct:'Inform the police and make MLC',options:['Take consent for abortion and proceed','Inform the police and make MLC','Take parents consent for MTP','None of these'],exp:'A 15-year-old = minor. Pregnancy in a 15-year-old = STATUTORY RAPE under POCSO Act 2012 (any sexual act with a person <18 is an offence regardless of consent). MANDATORY REPORTING: Section 19 of POCSO mandates ANY person (including doctors) who knows of sexual abuse of a child to IMMEDIATELY report to police \u2014 failure is a criminal offence. Attendants\\' unwillingness is IRRELEVANT \u2014 the obligation is on the doctor, not the family. MLC registration is mandatory. Police reporting takes precedence before any MTP consideration. Answer: Inform the police and make MLC.'},\n{id:58,stem:'Which of the following is an absolute contraindication for use of oral contraceptive pills?',correct:'Focal Migraine',options:['Epilepsy','Smoking','Focal Migraine','Bronchial Asthma'],exp:'WHO MEC Category 4 (absolute contraindication) for COCs: FOCAL\/CLASSIC MIGRAINE WITH AURA \u2714 \u2014 oestrogen increases risk of ischaemic stroke; migraine with aura is a strong independent stroke risk factor; combination = WHO Category 4 = absolute contraindication. Also Cat 4: current breast cancer, DVT\/PE, IHD, stroke, liver tumours\/severe cirrhosis, SLE + antiphospholipid antibodies, smoking + age >35 + heavy. EPILEPSY: not a contraindication (enzyme-inducing AEDs reduce COC efficacy \u2014 use higher dose). SMOKING alone (without age >35): Category 2\u20133. BRONCHIAL ASTHMA: not a contraindication. Answer: Focal Migraine.'},\n{id:59,stem:'The amount of Ethinyl Estradiol in third generation combined oral contraceptive pills is:',correct:'20\u201330 mcg',options:['10\u201320 mcg','20\u201330 mcg','30\u201335 mcg','35\u201350 mcg'],exp:'OCP oestrogen content evolution: 1st generation: 50\u2013150 mcg EE. 2nd generation: 30\u201335 mcg EE + levonorgestrel\/norethisterone. 3rd GENERATION: 20\u201330 mcg EE + newer progestins (desogestrel, gestodene, norgestimate) \u2014 lower oestrogen, fewer oestrogenic side effects. Examples: Marvelon (EE 30 mcg + desogestrel 150 mcg), Mercilon (EE 20 mcg + desogestrel 150 mcg). 4th generation: 10\u201320 mcg (ultra-low dose). Third generation EE = 20\u201330 mcg. Answer: 20\u201330 mcg.'},\n{id:60,stem:'Which one of the following clinical situations is NOT ideal to perform female sterilisation?',correct:'7 days postpartum',options:['Postmenstrual period','7 days postpartum','Concurrent with MTP','3 months post abortion'],exp:'Ideal timing for tubectomy: Postmenstrual (interval) \u2714 \u2014 1\u20132 weeks after menstruation; uterus small, not pregnant. Concurrent with MTP \u2714 \u2014 simultaneous; one anaesthetic; uterus accessible. 3 months post abortion \u2714 \u2014 uterus returned to normal; safe interval sterilisation. NOT IDEAL \u2014 7 DAYS POSTPARTUM: best postpartum timing is within 48 hours (uterus large, infraumbilical approach easy) OR after 6 weeks. At 7 days: uterus is involuting, soft, highly vascular \u2192 high risk of haemorrhage and infection; technically very difficult. Answer: 7 days postpartum.'},\n{id:61,stem:'Cardiac diseases in pregnancy with major risk of maternal mortality:\\n1. Pulmonary hypertension\\n2. Aortic coarctation with valvular involvement\\n3. Atrial septal defect\\n4. Mitral stenosis\\nSelect correct answer:',correct:'1 and 2',options:['1 and 4','2 and 3','1 and 2','3 and 4'],exp:'WHO Category IV cardiac conditions in pregnancy (pregnancy contraindicated \u2014 major mortality risk): Pulmonary Arterial Hypertension (PAH) \u2714 \u2014 maternal mortality 30\u201356%; fixed pulmonary vascular resistance cannot accommodate pregnancy-related haemodynamic demands. Aortic coarctation with valvular involvement \u2714 \u2014 severe aortic disease + valvular pathology carries high risk (aortic dissection, fixed outflow obstruction). ATRIAL SEPTAL DEFECT: generally well-tolerated (low-pressure left-to-right shunt); NOT a major mortality risk (WHO Class II). MITRAL STENOSIS: moderate-severe MS has significant morbidity but usually WHO Class III not IV (unless critical). PAH and coarctation with valvular disease = highest mortality. Answer: 1 and 2.'},\n{id:62,stem:'Pregnancy can be terminated at any gestation if the fetus is diagnosed to have:',correct:'Anencephaly',options:['Duodenal atresia','Bilateral talipes','Anencephaly','Hydrocephalus'],exp:'MTP Act India: Standard limit 24 weeks (post-2021 amendment for certain categories). Beyond 24 weeks: termination permitted for LETHAL fetal conditions confirmed by Medical Board. ANENCEPHALY \u2714 \u2014 absence of cranial vault and brain; universally fatal (stillborn or dies within hours); 100% lethal. No treatment possible. Pregnancy can be terminated AT ANY GESTATION. Duodenal atresia: surgically correctable (associated with Down syndrome \u2014 not invariably lethal). Bilateral talipes: correctable orthopaedic condition. Hydrocephalus: severity varies; shunting possible. Anencephaly = invariably lethal = termination at any gestation permitted. Answer: Anencephaly.'},\n{id:63,stem:'Which one of the following is NOT a cause of recurrent spontaneous abortion?',correct:'Rubella infection',options:['Chromosomal abnormality','Antiphospholipid syndrome','Rubella infection','Inherited thrombophilia'],exp:'Recurrent Pregnancy Loss (RPL \u2014 3+ consecutive losses) causes: Chromosomal \u2714 \u2014 parental balanced translocations (2\u20135%); de novo embryo errors. Antiphospholipid syndrome \u2714 \u2014 most important treatable cause; anticardiolipin Ab\/lupus anticoagulant \u2192 placental thrombosis \u2192 recurrent losses (typically 2nd trimester). Inherited thrombophilia \u2714 \u2014 Factor V Leiden, prothrombin G20210A, protein C\/S deficiency. Also: uterine anomalies (septum), cervical incompetence, endocrine causes, unexplained. RUBELLA: acute infection causes congenital rubella syndrome in 1st trimester \u2014 NOT a cause of RECURRENT abortion (immunity develops after single infection; not a recurring risk). Answer: Rubella infection.'},\n{id:64,stem:'The congenital abnormality which is invariably lethal:\\n1. Anencephaly\\n2. Transposition of great vessels\\n3. Down Syndrome\\nSelect correct answer:',correct:'1 only',options:['1 only','1 and 3','1 and 2','2 and 3'],exp:'ANENCEPHALY \u2714 \u2014 100% lethal; absence of cranial vault and brain; stillborn or dies within hours\/days; no treatment possible. TRANSPOSITION OF GREAT VESSELS (TGA): potentially lethal without treatment BUT arterial switch operation (Jatene) achieves >95% survival. NOT invariably lethal with modern surgery. DOWN SYNDROME (Trisomy 21): NOT lethal \u2014 life expectancy 60\u201370 years with support; good quality of life possible. Only Anencephaly is universally and invariably lethal. Answer: 1 only.'},\n{id:65,stem:'For vaginal breech delivery, ideal selection criteria include:\\n1. Fetus not compromised\\n2. Adequate pelvis\\n3. Extended breech presentation\\n4. Estimated fetal weight < 3.5 kg\\nSelect correct answer:',correct:'1, 2, 3 and 4',options:['1, 2 and 3 only','1, 2, 3 and 4','1, 3 and 4 only','2 and 4 only'],exp:'Criteria for vaginal breech delivery (selected cases): (1) Fetus not compromised \u2714 \u2014 no fetal distress; reassuring CTG. (2) Adequate pelvis \u2714 \u2014 clinical\/radiological pelvimetry confirming no contracted pelvis. (3) Extended (frank) breech \u2714 \u2014 hips flexed, knees extended; most favourable position; footling breech contraindicated (cord prolapse risk). (4) EFW <3.5 kg \u2714 \u2014 safe fetal size; macrosomia increases risk of head entrapment. Also required: experienced obstetrician, singleton, 37\u201342 weeks, no placenta praevia. All four are valid selection criteria. Answer: 1, 2, 3 and 4.'},\n{id:66,stem:'In which of the following presentations is vaginal delivery NOT possible?\\n1. Brow presentation\\n2. Left mento anterior position\\n3. Occipito posterior position\\n4. Breech presentation',correct:'1 only',options:['1, 2 and 3','1 and 3 only','1 only','4 only'],exp:'BROW PRESENTATION \u2714 NOT possible \u2014 mentovertical diameter ~13.5 cm (largest); cannot engage in normal pelvis. Persistent brow = CS unless converts to face (extension) or vertex (flexion). LEFT MENTO ANTERIOR (face, chin anterior) \u2714 POSSIBLE \u2014 chin anterior; neck extends under pubic arch; vaginal delivery feasible. MENTO POSTERIOR = NOT possible. OCCIPITO POSTERIOR \u2714 POSSIBLE \u2014 most rotate to OA spontaneously; persistent OP can deliver vaginally (\"face to pubes\"). BREECH \u2714 POSSIBLE \u2014 in carefully selected cases. Only BROW = vaginal delivery impossible. Answer: 1 only.'},\n{id:67,stem:'The blood supply of the uterus is from:\\n1. Uterine artery\\n2. Ovarian artery\\n3. Pudendal artery\\n4. Superior vesical artery\\nSelect correct answer:',correct:'1 and 2',options:['1 and 2','2 and 4','1 and 3','3 and 4'],exp:'Uterine blood supply: PRIMARY \u2014 UTERINE ARTERY \u2714 (branch of internal iliac anterior division; crosses ureter at internal os \u2014 \"water under the bridge\"; supplies most of uterus). SECONDARY \u2014 OVARIAN ARTERY \u2714 (branch of aorta; descends in infundibulopelvic ligament; anastomoses with uterine artery in broad ligament; supplies fundus). Pudendal artery: supplies perineum, clitoris, labia, lower vagina \u2014 NOT uterus. Superior vesical artery: supplies bladder \u2014 NOT uterus. Rich uterine-ovarian anastomosis explains why bilateral uterine artery ligation may fail. Answer: 1 and 2.'},\n{id:68,stem:'Which one of the following regarding amniotic fluid is true?',correct:'It reveals information about fetal lung maturity and wellbeing',options:['The volume is highest at 28 weeks','It reveals information about fetal lung maturity and wellbeing','It is decreased in duodenal atresia in baby','It is decreased in gestational diabetes'],exp:'Amniotic fluid facts: Volume peaks at 34\u201336 weeks (~800\u20131000 mL) \u2014 NOT at 28 weeks (still increasing). Duodenal atresia \u2192 POLYHYDRAMNIOS (cannot swallow \u2192 fluid accumulates) \u2014 NOT decreased. Gestational diabetes \u2192 POLYHYDRAMNIOS (fetal hyperglycaemia \u2192 polyuria \u2192 increased AF) \u2014 NOT decreased. REVEALS INFORMATION \u2714 \u2014 amniocentesis provides: L\/S ratio >2.0 = fetal lung maturity, phosphatidylglycerol (lung maturity), bilirubin OD450 (haemolytic disease), karyotype, AFP, fetal wellbeing assessment. Answer: It reveals information about fetal lung maturity and wellbeing.'},\n{id:69,stem:'Statements regarding changes in pregnancy:\\n1. Plasma volume increases up to 30\u201350%\\n2. Pregnancy is a hypercoagulable state\\n3. Haematocrit is decreased\\n4. Total plasma proteins increases\\nWhich are correct?',correct:'1, 2 and 3',options:['1 only','1, 2, 3 and 4','1 and 2 only','1, 2 and 3'],exp:'(1) Plasma volume \u2714 increases 40\u201350% (peaks 28\u201334 wks). (2) Hypercoagulable \u2714 \u2014 factors I (fibrinogen), VII, VIII, IX, X, XII \u2191; protein S \u2193; fibrinolysis impaired \u2192 protects from PPH but increases VTE risk. (3) Haematocrit DECREASES \u2714 \u2014 haemodilution (plasma \u2191 > RBC \u2191) \u2192 physiological anaemia of pregnancy. (4) Total plasma proteins: albumin DECREASES (dilution effect); total plasma protein concentration generally decreases. Fibrinogen increases but is classified separately. Per standard teaching: protein concentration decreases in pregnancy. Statements 1, 2, 3 are correct; statement 4 is not universally correct. Answer: 1, 2 and 3.'},\n{id:70,stem:'Which one of the following statements regarding anatomy of fetal head is NOT true?',correct:'Lambdoid suture separates the two parietal bones',options:['Coronal suture separates frontal bones from parietal bones','Lambdoid suture separates the two parietal bones','Frontal suture separates the two frontal bones','Bregma is a diamond shaped space at junction of coronal and sagittal sutures'],exp:'Fetal skull sutures: Coronal suture \u2714 \u2014 separates FRONTAL from PARIETAL bones (transverse). Frontal suture \u2714 \u2014 separates the TWO FRONTAL BONES (midline anterior). Bregma (anterior fontanelle) \u2714 \u2014 diamond-shaped; junction of coronal + frontal + sagittal sutures. LAMBDOID SUTURE: separates the TWO PARIETAL BONES from the OCCIPITAL BONE \u2014 NOT between the two parietals. The SAGITTAL SUTURE separates the two parietal bones from each other (midline, front to back). \"Lambdoid separates the two parietal bones\" is FALSE. Answer: Lambdoid suture separates the two parietal bones.'},\n{id:71,stem:'A 30-year-old, mother of 3, stage 3 prolapse, moderate cystocele, no posterior vaginal wall prolapse. Recommended surgery:\\n1. Cystocele repair\\n2. Rectocele repair\\n3. Manchester operation\\n4. Vaginal hysterectomy\\nSelect correct answer:',correct:'1, 2 and 4',options:['1 and 3 only','1, 2 and 3','3 only','1, 2 and 4'],exp:'Stage 3 uterovaginal prolapse + moderate cystocele, family complete (3 children): VAGINAL HYSTERECTOMY \u2714 \u2014 definitive treatment for significant uterovaginal prolapse. CYSTOCELE REPAIR (anterior colporrhaphy) \u2714 \u2014 for the moderate cystocele. Posterior colpoperineorrhaphy (rectocele repair) \u2014 conventionally performed as part of repair suite; standard answer includes it. MANCHESTER OPERATION \u2014 for cervical elongation with lesser degrees of prolapse when uterus preservation desired; at Stage 3 in a multiparous woman, vaginal hysterectomy preferred. Standard UPSC answer for this scenario: 1, 2 and 4 (vaginal hysterectomy + cystocele repair + posterior repair as combined vault repair). Answer: 1, 2 and 4.'},\n{id:72,stem:'A 50-year-old post-menopausal woman with bleeding per vaginum. Which investigation is NOT required?',correct:'Diagnostic laparoscopy',options:['Endometrial biopsy','Diagnostic laparoscopy','Hysteroscopy','Pap smear'],exp:'Post-menopausal bleeding (PMB) workup: Endometrial biopsy \u2714 \u2014 essential; rules out endometrial carcinoma (most common cause). Pipelle\/D&C biopsy. Hysteroscopy \u2714 \u2014 gold standard; visualises uterine cavity; directed biopsy; detects polyps, fibroids, carcinoma. Pap smear \u2714 \u2014 excludes cervical carcinoma. TVS \u2014 endometrial thickness (>4 mm = suspicious). DIAGNOSTIC LAPAROSCOPY: evaluates PERITONEAL CAVITY and external pelvic organs \u2014 has no role in evaluating endometrial\/cervical causes of PMB (which are intrauterine\/intraluminal). Laparoscopy sees OUTSIDE the uterus, not the endometrium. NOT required for routine PMB evaluation. Answer: Diagnostic laparoscopy.'},\n{id:73,stem:'Statements regarding \u03b2-hCG that are NOT correct:\\n1. It is a glycoprotein hormone\\n2. Serum levels increase in pregnancy, germ cell tumour and GTD\\n3. Its levels are same in single and multiple pregnancy\\n4. It has common Alpha-subunit with FSH, LH and TSH\\nSelect the NOT correct statements:',correct:'3 only',options:['1, 2 and 4','1, 2 and 3','2, 3 and 4','3 only'],exp:'\u03b2-hCG analysis: (1) Glycoprotein \u2714 TRUE \u2014 alpha + beta subunits, both glycosylated. (2) Levels increase in pregnancy, germ cell tumours, GTD \u2714 TRUE. (3) Levels same in single and multiple pregnancy: NOT CORRECT \u2714 \u2014 levels are HIGHER in multiple pregnancy (more trophoblastic tissue); also higher in molar pregnancy. (4) Common alpha-subunit with FSH, LH, TSH \u2714 TRUE \u2014 all four pituitary\/placental glycoproteins share identical alpha subunit; beta subunit confers specificity. Only statement 3 is NOT correct. Per UPSC answer key convention: Answer: 3 only.'},\n{id:74,stem:'Which one of the following is NOT an emergency contraception method?',correct:'Norplant',options:['Levonorgestrel','Norplant','Intra uterine contraceptive device','High dose oral contraceptive pill'],exp:'Emergency contraception methods: Levonorgestrel \u2714 (1.5 mg single dose or 0.75 mg \u00d7 2 within 72 hours \u2014 most widely used EC). High-dose OCP \u2714 (Yuzpe method: EE 100 mcg + LNG 0.5 mg \u00d7 2 doses, 12h apart, within 72h). Copper IUCD \u2714 (most effective EC >99%; inserted within 5 days). Also: mifepristone (low dose). NORPLANT: subdermal implant (6 LNG rods) \u2014 provides 5 years of ONGOING regular contraception; cannot be inserted as emergency post-coital contraception. NOT an emergency contraceptive. Answer: Norplant.'},\n{id:75,stem:'All of the following statements are correct about vasectomy EXCEPT:',correct:'It increases the incidence of testicular cancer',options:['No Scalpel Vasectomy was first developed in China','It increases the incidence of testicular cancer','It is less time consuming than tubectomy','Additional contraception should be used for 3 months after vasectomy'],exp:'Vasectomy facts: NSV first developed in China \u2714 (Dr Li Shunqiang, 1974; now global standard). Less time consuming than tubectomy \u2714 (10\u201320 min, local anaesthesia vs general\/regional for tubectomy). Additional contraception for 3 months \u2714 (residual sperms; confirm azoospermia after ~20 ejaculations). TESTICULAR CANCER: large prospective studies conclusively show NO increased risk of testicular cancer with vasectomy. Earlier studies had methodological flaws; this has been refuted. Vasectomy does NOT increase testicular cancer risk. Answer: It increases testicular cancer incidence \u2014 NOT correct.'},\n{id:76,stem:'Which statement regarding anaemia in pregnancy is NOT true?',correct:'If mother is severely anaemic, the fetus is also severely anaemic',options:['Iron deficiency anaemia is most common in Tropics','Faulty dietary habit is one of the factors responsible','Mild anaemia is most common','If mother is severely anaemic, the fetus is also severely anaemic'],exp:'Anaemia in pregnancy: Iron deficiency most common in tropics \u2714 (~75% of anaemia in pregnancy in developing countries). Faulty dietary habits \u2714 \u2014 inadequate iron\/folate; phytates reduce iron absorption. Mild anaemia most common \u2714 (Hb 9\u201311 g\/dL is mild; severe = Hb <7 g\/dL). FETAL ANAEMIA: the fetus has PRIORITY access to maternal iron via active transport across the placenta \u2014 even in severe maternal anaemia, the fetus maintains near-normal haemoglobin levels (fetal Hb is NOT proportionately low). \"If mother is severely anaemic, fetus is also severely anaemic\" is NOT TRUE. The placenta actively transports iron to the fetus preferentially. Answer: If mother severely anaemic, fetus also severely anaemic \u2014 NOT true.'},\n{id:77,stem:'Which one of the following statements about male sterilisation is NOT true?',correct:'It is performed under general anaesthesia',options:['It is safer and less expensive','Most men develop antisperm antibodies','It has a low failure rate','It is performed under general anaesthesia'],exp:'Male sterilisation (vasectomy) facts: Safer and less expensive \u2714 \u2014 compared to tubectomy; outpatient procedure, local anaesthesia, fewer complications. Antisperm antibodies \u2714 \u2014 majority of men (~70%) develop antisperm antibodies post-vasectomy; clinically significant in reversal attempts. Low failure rate \u2714 \u2014 failure rate ~0.1% (among the most effective reversible or permanent contraceptive methods). GENERAL ANAESTHESIA: vasectomy is performed under LOCAL ANAESTHESIA \u2014 NOT general anaesthesia. This is one of its major advantages over tubectomy (which may require general\/regional). Answer: Performed under general anaesthesia \u2014 NOT true.'},\n{id:78,stem:'Which of the following is NOT a method of second trimester abortion?',correct:'Mifepristone and PGE1',options:['Mifepristone and PGE1','PGE2 analog','Intra-amniotic KCl instillation','Hysterotomy'],exp:'Second trimester abortion (13\u201324 weeks) methods: PGE2 analogue \u2714 (dinoprostone \u2014 vaginal, extra-amniotic instillation \u2014 valid 2nd trimester method). Intra-amniotic KCl instillation \u2714 (feticide \u2014 used in selective fetal reduction and late termination; potassium chloride injected into fetal heart under USS guidance). Hysterotomy \u2714 (surgical \u2014 mini-laparotomy; rarely used but valid for 2nd trimester). MIFEPRISTONE + PGE1 (misoprostol): Mifepristone 200 mg + misoprostol is the standard FIRST TRIMESTER medical abortion regimen (up to 10\u201312 weeks). While misoprostol alone can be used in 2nd trimester, the combination of mifepristone + PGE1 is primarily a 1st trimester regimen. For 2nd trimester, PGE2 or extra-amniotic methods are used. Answer: Mifepristone and PGE1 \u2014 NOT a 2nd trimester method.'},\n{id:79,stem:'During MTP by suction and evacuation, perforation of uterus occurred with cannula. The next step should be:',correct:'Laparotomy with exploration of bowel',options:['Laparotomy with exploration of bowel','Manual vacuum aspiration','Wait and watch','Complete the evacuation with curette'],exp:'Uterine perforation during MTP: Perforation by a CANNULA (suction) is a potentially serious complication. Management depends on the instrument and suspected damage: Perforation by a blunt instrument (dilator) in a stable patient: may watch closely. Perforation by SHARP\/SUCTION INSTRUMENT (cannula): HIGH RISK of bowel injury \u2014 the suction cannula may have aspirated bowel. IMMEDIATE LAPAROTOMY is required to: (1) Inspect and repair the uterine perforation. (2) EXPLORE THE BOWEL for inadvertent bowel injury (which, if missed, causes peritonitis and sepsis). Continuing evacuation risks further bowel aspiration. Wait and watch is dangerous. MVA will not address the bowel injury. Answer: Laparotomy with exploration of bowel.'},\n{id:80,stem:'Statements regarding MTP (Medical Termination of Pregnancy):\\n1. Suction and evacuation can be done up till 12 weeks\\n2. Medical methods can be used up till 10 weeks\\n3. Manual vacuum aspiration (MVA) syringe can be used up to 6 weeks\\nWhich are correct?',correct:'1 only',options:['1 only','2 and 3','2 only','1 and 3'],exp:'MTP methods and gestational limits: (1) Suction and evacuation (electric vacuum aspiration \/ sharp curettage) up to 12 weeks \u2714 \u2014 standard first-trimester surgical method; widely used up to 12 weeks gestation. (2) Medical methods (mifepristone + misoprostol) up to 10 weeks: PARTIALLY correct \u2014 MTP Act 2021 and WHO guidelines support medical abortion up to 9\u201310 weeks (some protocols up to 12 weeks with higher misoprostol doses). But the standard Indian MTP teaching = up to 9 weeks (not 10). Statement 2 is approximately correct but 9 weeks is the standard cut-off in many references. (3) MVA up to 6 weeks: INCORRECT \u2014 MVA can be used up to 12 weeks (same as EVA\/surgical); the double-valve MVA syringe is effective up to 10\u201312 weeks. Not limited to 6 weeks. Per standard UPSC answer: Statement 1 only is unambiguously correct. 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Submitting in 10 Submit Now Combined Medical Services Examination 2018Paper 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-36812","post","type-post","status-publish","format-standard","hentry","category-cms","category-obg"],"yoast_head":"\n<title>CMS 2018 P2 Part-B - 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\/11\/cms-2018-p2-part-b\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2018 P2 Part-B - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2018 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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