CMS 2019 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#cms19p2b*,#cms19p2b *::before,#cms19p2b *::after{box-sizing:border-box;margin:0;padding:0}\n#cms19p2b{--ter:#C0603A;--ter-pale:#fdf1ec;--teal:#2A7A6F;--teal-light:#3da394;--teal-pale:#eaf4f3;--ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;--line:#e0d8d4;--bg:#fdfaf8;--white:#fff;--cb:#43a047;--cb-bg:#eaf7ef;--wb:#e53935;--wb-bg:#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#cms19p2b .sen{height:1px}\n#cms19p2b .sb{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,.11);opacity:0;pointer-events:none;transform:translateY(-110%);transition:opacity .22s,transform .22s}\n#cms19p2b .sb.vis{opacity:1;pointer-events:auto;transform:translateY(0)}\n#cms19p2b .sb-row{display:flex;align-items:center;padding:.38rem .7rem;font-size:.73rem;color:var(--ink-soft)}\n#cms19p2b .sb-it{display:flex;align-items:center;gap:.18rem;padding:.1rem .5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1}\n#cms19p2b .sb-it:last-child{border-right:none}\n#cms19p2b .sb-it strong{color:var(--ink);font-size:.8rem;font-weight:700}\n#cms19p2b .sb-sep{flex:1}\n#cms19p2b .sb-bar{height:4px;background:var(--line);overflow:hidden}\n#cms19p2b .sb-fill{height:100%;background:linear-gradient(90deg,var(--ter),var(--teal));width:0%;transition:width .4s}\n#cms19p2b .ti{display:none;align-items:center;gap:.18rem;padding:.1rem .5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1;font-size:.73rem}\n#cms19p2b .ti.on{display:flex}\n#cms19p2b .ti strong{font-size:.8rem;font-weight:700;color:var(--teal);font-variant-numeric:tabular-nums}\n#cms19p2b .ti.warn strong{color:var(--wb)}\n#cms19p2b .grace{display:none;position:fixed;inset:0;z-index:999999;background:rgba(0,0,0,.55);align-items:center;justify-content:center}\n#cms19p2b .grace.show{display:flex}\n#cms19p2b .gb{background:var(--white);border-radius:12px;border-top:5px solid var(--wb);padding:32px 28px;text-align:center;max-width:320px;width:90%;box-shadow:0 8px 40px rgba(0,0,0,.25)}\n#cms19p2b .gb h3{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--wb);margin-bottom:10px}\n#cms19p2b .gb p{font-size:.88rem;color:var(--ink-mid);margin-bottom:18px;line-height:1.55}\n#cms19p2b .gc{font-family:'Playfair Display',serif;font-size:2.8rem;font-weight:700;color:var(--wb);line-height:1;margin-bottom:18px}\n#cms19p2b .gnow{background:var(--wb);color:#fff;border:none;border-radius:8px;padding:10px 24px;font-family:'Playfair Display',serif;font-size:.95rem;font-weight:700;cursor:pointer}\n#cms19p2b .hdr{background:var(--teal);color:var(--white);padding:28px 24px 22px;text-align:center}\n#cms19p2b .hdr h1{font-family:'Playfair Display',serif;font-size:1.45rem;font-weight:700;line-height:1.3}\n#cms19p2b .hdr p{font-size:.85rem;opacity:.85;margin-top:6px;font-style:italic}\n#cms19p2b .meta{display:flex;justify-content:center;gap:16px;margin-top:14px;flex-wrap:wrap;align-items:center}\n#cms19p2b .bdg{background:rgba(255,255,255,.15);border:1px solid rgba(255,255,255,.3);border-radius:20px;padding:4px 14px;font-size:.78rem}\n#cms19p2b .tbtn{background:transparent;border:1.5px solid rgba(255,255,255,.7);color:var(--white);border-radius:20px;padding:4px 14px;font-family:'Source Serif 4',serif;font-size:.78rem;cursor:pointer;transition:background .2s}\n#cms19p2b .tbtn:hover{background:rgba(255,255,255,.15)}\n#cms19p2b .tbtn.run{background:rgba(255,255,255,.2);border-color:var(--white)}\n#cms19p2b .body{max-width:760px;margin:0 auto;padding:0 16px}\n#cms19p2b .card{background:var(--white);border:1px solid var(--line);border-radius:var(--r);margin:24px 0;overflow:hidden;transition:box-shadow .2s}\n#cms19p2b .card:hover{box-shadow:0 2px 12px rgba(192,96,58,.1)}\n#cms19p2b .qh{background:var(--ter-pale);border-bottom:1px solid var(--line);padding:14px 18px;display:flex;gap:12px;align-items:flex-start}\n#cms19p2b .qn{flex-shrink:0;width:26px;height:26px;border-radius:50%;background:var(--ter);color:#fff;font-size:.72rem;font-weight:700;display:flex;align-items:center;justify-content:center;margin-top:2px;transition:background .2s}\n#cms19p2b .qn.c{background:var(--cb)}\n#cms19p2b .qn.w{background:var(--wb)}\n#cms19p2b .qt{font-size:.93rem;color:var(--ink);line-height:1.65}\n#cms19p2b .opts{padding:14px 18px;display:flex;flex-direction:column;gap:8px}\n#cms19p2b .opt{display:flex;align-items:flex-start;gap:10px;padding:10px 14px;border:1.5px solid var(--line);border-radius:8px;cursor:pointer;transition:border-color .15s,background .15s;background:var(--white);-webkit-tap-highlight-color:transparent}\n#cms19p2b .opt:hover:not(.lk){border-color:var(--teal);background:var(--teal-pale)}\n#cms19p2b .ol{flex-shrink:0;width:20px;height:20px;border-radius:50%;border:1.5px solid var(--line);display:flex;align-items:center;justify-content:center;font-size:.65rem;font-weight:700;color:var(--ink-soft);margin-top:1px;transition:all .15s}\n#cms19p2b .ot{font-size:.89rem;color:var(--ink-mid);line-height:1.55}\n#cms19p2b .opt.co{border-color:var(--cb);background:var(--cb-bg);cursor:default}\n#cms19p2b .opt.co .ol{background:var(--cb);border-color:var(--cb);color:#fff}\n#cms19p2b .opt.co .ot{color:#1e6f46;font-weight:600}\n#cms19p2b .opt.wr{border-color:var(--wb);background:var(--wb-bg);cursor:default}\n#cms19p2b .opt.wr .ol{background:var(--wb);border-color:var(--wb);color:#fff}\n#cms19p2b .opt.wr .ot{color:var(--wb)}\n#cms19p2b .opt.dm{opacity:.42;cursor:default}\n#cms19p2b .opt.lk{cursor:default}\n#cms19p2b .exp{display:none;background:var(--teal-pale);border-top:1px solid #b2d8d3;padding:10px 18px 12px;font-size:.82rem;color:#1a4f49;line-height:1.62}\n#cms19p2b .exl{font-size:.7rem;font-weight:700;letter-spacing:.08em;text-transform:uppercase;color:var(--teal);margin-bottom:4px}\n#cms19p2b .sw{text-align:center;padding:28px 16px 8px}\n#cms19p2b .btn{background:var(--teal);color:var(--white);border:none;border-radius:8px;padding:13px 36px;font-family:'Playfair Display',serif;font-size:1rem;font-weight:700;cursor:pointer;transition:background .2s,transform .1s}\n#cms19p2b .btn:hover{background:var(--teal-light)}\n#cms19p2b .btn:active{transform:scale(.98)}\n#cms19p2b .sc{display:none;background:var(--white);border:2px solid var(--teal);border-radius:var(--r);margin:28px 0 0;padding:28px 24px;text-align:center}\n#cms19p2b .ring{width:110px;height:110px;border-radius:50%;background:conic-gradient(var(--teal) 0%,var(--line) 0%);display:flex;align-items:center;justify-content:center;margin:0 auto 20px;position:relative}\n#cms19p2b .ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms19p2b .ri{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms19p2b .rp{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms19p2b .rs{font-size:.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:.05em}\n#cms19p2b .sc h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms19p2b .nl{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms19p2b .vd{font-size:.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms19p2b .bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:.8rem}\n#cms19p2b .band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms19p2b .bc{background:var(--cb-bg);color:#1e6f46}\n#cms19p2b .bw{background:var(--wb-bg);color:var(--wb)}\n#cms19p2b .bs{background:var(--teal-pale);color:var(--teal)}\n#cms19p2b .rbtn{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:.95rem;font-weight:700;cursor:pointer;transition:background .2s,color .2s}\n#cms19p2b .rbtn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){#cms19p2b .hdr h1{font-size:1.15rem}#cms19p2b .qt{font-size:.88rem}#cms19p2b .ot{font-size:.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms19p2b\">\n<div class=\"sen\" id=\"cms19p2b-sen\"><\/div>\n<div class=\"sb\" id=\"cms19p2b-sb\">\n <div class=\"sb-row\">\n <div class=\"ti\" id=\"cms19p2b-ti\">\u23f1 <strong id=\"cms19p2b-td\">40:00<\/strong><\/div>\n <div class=\"sb-it\">\u2705 <strong id=\"cms19p2b-sc\">0<\/strong><\/div>\n <div class=\"sb-it\">\u274c <strong id=\"cms19p2b-sw\">0<\/strong><\/div>\n <div class=\"sb-it\">\u23f3 <strong id=\"cms19p2b-sr\">40<\/strong> left<\/div>\n <div class=\"sb-sep\"><\/div>\n <div class=\"sb-it\">Net <strong id=\"cms19p2b-sn\">0<\/strong> \/ <strong id=\"cms19p2b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"sb-bar\"><div class=\"sb-fill\" id=\"cms19p2b-fill\"><\/div><\/div>\n<\/div>\n<div class=\"grace\" id=\"cms19p2b-grace\">\n <div class=\"gb\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"gc\" id=\"cms19p2b-gc\">10<\/div>\n <button class=\"gnow\" id=\"cms19p2b-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"hdr\">\n <h1>Combined Medical Services Examination 2019<br>Paper II \u00b7 Part B<\/h1>\n <p>Obstetrics & Gynaecology<\/p>\n <div class=\"meta\">\n <span class=\"bdg\">Questions 41 \u2013 80<\/span>\n <span class=\"bdg\">Options reshuffled<\/span>\n <button class=\"tbtn\" id=\"cms19p2b-tbtn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"body\">\n <div id=\"cms19p2b-qs\"><\/div>\n <div class=\"sw\"><button class=\"btn\" id=\"cms19p2b-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms19p2b-sc-box\">\n <div class=\"ring\" id=\"cms19p2b-ring\"><div class=\"ri\"><span class=\"rp\" id=\"cms19p2b-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms19p2b-nl\"><\/div>\n <div class=\"vd\" id=\"cms19p2b-vd\"><\/div>\n <div class=\"bands\">\n <span class=\"band bc\" id=\"cms19p2b-bc\"><\/span>\n <span class=\"band bw\" id=\"cms19p2b-bw\"><\/span>\n <span class=\"band bs\" id=\"cms19p2b-bs\"><\/span>\n <\/div>\n <button class=\"rbtn\" id=\"cms19p2b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms19p2b',TOTAL=40,MAX=160,TSECS=2400,GSECS=10;\nvar QS=[\n{id:41,stem:'Which of the following is NOT the hormonal basis for hyperemesis gravidarum?',correct:'Excess of Human Placental Lactogen',options:['Excess of Chorionic Gonadotropin','Excess of Human Placental Lactogen','Excess of Progesterone','High serum levels of Estrogen'],exp:'Hyperemesis gravidarum \u2014 proposed hormonal mechanisms: EXCESS hCG \u2714 \u2014 strongest evidence; peak hCG at 8\u201312 weeks correlates with peak vomiting; higher hCG in molar pregnancy\/multiple gestation \u2192 severe HG. HIGH OESTROGEN \u2714 \u2014 exogenous oestrogen causes nausea; levels correlate with severity. EXCESS PROGESTERONE \u2714 \u2014 relaxes gastric smooth muscle \u2192 delayed gastric emptying \u2192 nausea. HUMAN PLACENTAL LACTOGEN (hPL) \u2717 \u2014 hPL is produced by the syncytiotrophoblast and regulates fetal nutrition\/IGF axis; it does NOT have a recognised role in the causation of nausea and vomiting of pregnancy. Answer: Excess of Human Placental Lactogen.'},\n{id:42,stem:'Consider the following statements regarding pregnancy with Rh isoimmunisation:\\n1. Indirect Coombs test is performed in mother\\n2. Methergin is withheld at delivery of anterior shoulder\\n3. Middle cerebral artery peak systolic velocity is an accurate method to predict fetal anaemia\\nWhich of the statements given above are correct?',correct:'1 and 3 only',options:['1 and 2 only','1, 2 and 3','2 and 3 only','1 and 3 only'],exp:'Statement 1 \u2714 \u2014 INDIRECT Coombs test (ICT) is performed on MATERNAL serum to detect antibodies (anti-D) in the mother\\'s circulation. Direct Coombs test is done on fetal\/neonatal red cells. Statement 2 \u2717 \u2014 METHERGIN (methylergometrine) is withheld at delivery of the ANTERIOR SHOULDER in Rh-negative mothers (NOT because of Rh isoimmunisation per se); actually Methergin is withheld to avoid tetanic uterine contraction that would force fetal blood into maternal circulation increasing fetomaternal haemorrhage. However, the classical teaching is that Syntometrine\/Syntocinon is used but Methergin is avoided to reduce FMH risk. This statement is partly contextually incorrect for the specific indication. Statement 3 \u2714 \u2014 MCA-PSV (Mari\\'s criteria): MCA-PSV >1.5 MoM predicts moderate-to-severe fetal anaemia with high sensitivity (~100%), replacing amniocentesis for \u0394OD450. Correct statements: 1 and 3. Answer: 1 and 3 only.'},\n{id:43,stem:'In fetus with Spina bifida, which of the following sign\/signs may be seen on ultrasound?',correct:'All of these',options:['Lemon sign','Banana sign','Defect seen in vertebral bodies or tissue overlying it','All of these'],exp:'Ultrasound signs in fetal spina bifida (open neural tube defect): LEMON SIGN \u2714 \u2014 frontal bossing \/ scalloping of frontal bones giving a lemon shape on axial head section; due to herniation of hindbrain (Arnold-Chiari II) causing negative pressure on skull. BANANA SIGN \u2714 \u2014 cerebellum wraps around the brainstem into a curved banana shape (small posterior fossa, obliteration of cisterna magna) due to downward traction of hindbrain. DIRECT DEFECT \u2714 \u2014 posterior vertebral arch defect \u00b1 meningocele\/myelomeningocele sac visible in spine on sagittal\/coronal views. All three signs may be detected on second-trimester anomaly scan. Answer: All of these.'},\n{id:44,stem:'In pregnancy with Down syndrome, consider the following biomarkers:\\n1. \u03b2-hCG is raised\\n2. \u03b1-FP is raised\\n3. Inhibin is decreased\\nWhich of the above statements is\/are correct?',correct:'1 only',options:['1, 2 and 3','1 only','2 and 3 only','1 and 2 only'],exp:'Down syndrome (Trisomy 21) serum screening markers (Triple\/Quadruple test): \u03b2-hCG: RAISED \u2714 (statement 1 correct). \u03b1-FP (AFP): DECREASED \u2717 (statement 2 incorrect \u2014 AFP is LOW in Down syndrome; HIGH AFP suggests NTD\/abdominal wall defects). Inhibin A: RAISED \u2717 (statement 3 incorrect \u2014 Inhibin A is ELEVATED, not decreased, in Down syndrome; it is the fourth marker in the quadruple test). Unconjugated oestriol (uE3): decreased. Mnemonic for Down: hCG \u2191, AFP \u2193, uE3 \u2193, Inhibin A \u2191. Only statement 1 is correct. Answer: 1 only.'},\n{id:45,stem:'A 25-year-old G2P1L1, Rh-negative woman at 30 weeks gestation has a positive Indirect Coombs Test (ICT). What would be the next line of management?',correct:'ICT titers to be closely monitored at weekly intervals',options:['Anti-D to be given','ICT titers to be closely monitored at weekly intervals','Amniocentesis for estimation of bilirubin by Liley\\'s chart is to be done','Baby is to be delivered as soon as possible'],exp:'Positive ICT in an Rh-negative mother means she is ALREADY sensitised \u2014 Anti-D immunoglobulin is now USELESS (cannot prevent what has already happened). Management of established Rh sensitisation at 30 weeks: MONITOR ICT TITRES \u2714 \u2014 serial titres every 2\u20134 weeks. If titre <1:8 (or <1:16 by some criteria) \u2192 continue monitoring. If titre \u22651:16 \u2192 MCA-PSV Doppler (now preferred over amniocentesis). Amniocentesis for Liley\\'s chart is outdated; MCA-PSV has replaced it. Delivery at 30 weeks is premature without evidence of fetal compromise. Anti-D is pointless once sensitised. Answer: ICT titers to be closely monitored at weekly intervals.'},\n{id:46,stem:'Given below are obstetric manoeuvres and their indications. Which one of the following is correctly matched?',correct:'Ritgen\\'s manoeuvre \u2013 Controlled delivery of fetal head',options:['McRobert\\'s manoeuvre \u2013 After coming head of breech','Lovset\\'s manoeuvre \u2013 Delivery of foot in breech','Pinard\\'s manoeuvre \u2013 Delivery of extended arm','Ritgen\\'s manoeuvre \u2013 Controlled delivery of fetal head'],exp:'Obstetric manoeuvre matching: McRobert\\'s \u2717 \u2014 used for SHOULDER DYSTOCIA (hyperflexion of maternal thighs onto abdomen to open pelvic inlet), NOT for after-coming head of breech (that is Mauriceau-Smellie-Veit). Lovset\\'s \u2717 \u2014 for delivery of EXTENDED ARMS in breech (rotating the trunk to bring arm anteriorly), NOT for delivery of foot (Pinard\\'s is for foot). Pinard\\'s \u2717 \u2014 for delivery of extended LEGS\/FEET in frank breech (fingers placed on popliteal fossa to flex knee and bring leg down), NOT extended arm. Ritgen\\'s manoeuvre \u2714 \u2014 used for controlled delivery of the fetal HEAD in vertex delivery; fingers of one hand behind the perineum press upward on the fetal chin while the other hand controls cranial descent \u2014 prevents perineal tears. Answer: Ritgen\\'s manoeuvre \u2013 Controlled delivery of fetal head.'},\n{id:47,stem:'The maternal serum \u03b1-fetoprotein level is elevated in all EXCEPT:',correct:'Down syndrome',options:['Down syndrome','Neural tube defect','Intrauterine death','Omphalocele'],exp:'Causes of ELEVATED maternal serum AFP: NEURAL TUBE DEFECTS \u2714 \u2014 anencephaly, open spina bifida, encephalocele; AFP leaks from exposed neural tissue. INTRAUTERINE DEATH \u2714 \u2014 fetal tissue breakdown releases AFP. OMPHALOCELE \u2714 \u2014 abdominal wall defect; AFP leaks into amniotic fluid. Also: gastroschisis, multiple pregnancy, incorrect gestational age, Turner syndrome. DOWN SYNDROME (Trisomy 21) \u2717 \u2014 AFP is characteristically LOW\/DECREASED in Down syndrome (the triple screen: \u2193AFP, \u2191hCG, \u2193uE3). Down syndrome is the classic exception. Answer: Down syndrome.'},\n{id:48,stem:'Which one of the following statements regarding Bartholin\\'s glands is NOT true?',correct:'Gonococci is the most common causing Bartholin\\'s abscess',options:['They are situated in superficial perineal pouch','Duct opens at the junction between anterior one third and posterior two third between hymen and labium minus','Gonococci is the most common causing Bartholin\\'s abscess','The duct is lined by columnar epithelium'],exp:'Bartholin\\'s gland facts: Situated in superficial perineal pouch \u2714 \u2014 in the posterior part of the labium majus. Duct opening \u2714 \u2014 at the junction of the anterior 1\/3 and posterior 2\/3 of the groove between hymen and labium minus (at 4 and 8 o\\'clock). Gonococci as most common cause \u2717 \u2014 INCORRECT. In the past gonococci were the classic cause, but CURRENTLY the most common organisms in Bartholin\\'s abscess are MIXED ANAEROBES and skin commensals (E. coli, Bacteroides, Staphylococci); N. gonorrhoeae now accounts for only a small minority. Duct lined by columnar epithelium \u2714 \u2014 transitional near opening, columnar (mucous) in the gland. Answer: Gonococci is the most common causing Bartholin\\'s abscess.'},\n{id:49,stem:'An 18-year-old unmarried girl presents with heavy, prolonged bleeding during menses. Which among the following investigations is NOT usually advised?',correct:'Dilatation and curettage',options:['Urine pregnancy test','Ultrasound uterus and adnexa','Coagulation profile','Dilatation and curettage'],exp:'Work-up for heavy menstrual bleeding (HMB) in an 18-year-old: URINE PREGNANCY TEST \u2714 \u2014 must exclude pregnancy\/ectopic as a cause of abnormal uterine bleeding. ULTRASOUND \u2714 \u2014 to assess uterine and adnexal pathology (fibroid, polyp, ovarian cyst). COAGULATION PROFILE \u2714 \u2014 adolescent-onset HMB has a high prevalence of coagulation disorders (von Willebrand disease ~13%, ITP, platelet dysfunction). DILATATION AND CURETTAGE \u2717 \u2014 NOT indicated in a young adolescent as a first-line investigation; D&C is an invasive operative procedure not appropriate in virginal\/adolescent patients for diagnosis; endometrial malignancy is extremely rare at 18. Hysteroscopy \u00b1 directed biopsy would be preferred if needed. Answer: Dilatation and curettage.'},\n{id:50,stem:'Which one of the following is true about Basal Body Temperature?\\n1. Biphasic pattern\\n2. Increase in the level of progesterone and norepinephrine\\n3. Temperature falls by 0.5\u02daC after ovulation\\n4. It can predict ovulation precisely\\nSelect the correct answer:',correct:'1 and 2',options:['1 and 3','1 and 2','1 and 4','2 and 3'],exp:'Basal Body Temperature (BBT) chart: Statement 1 \u2714 \u2014 BBT shows a BIPHASIC pattern: lower in follicular phase, rises ~0.2\u20130.5\u00b0C after ovulation (progesterone-mediated), stays elevated in luteal phase. Statement 2 \u2714 \u2014 The post-ovulatory rise is due to increased PROGESTERONE (thermogenic effect); norepinephrine is also cited in thermogenic pathways (though progesterone is the primary mediator). Statement 3 \u2717 \u2014 Temperature RISES (not falls) by 0.2\u20130.5\u00b0C AFTER ovulation. Statement 4 \u2717 \u2014 BBT can confirm that ovulation HAS occurred but CANNOT PREDICT ovulation in advance; the rise is detected AFTER the LH surge\/ovulation. It is retrospective, not predictive. Correct: 1 and 2. Answer: 1 and 2.'},\n{id:51,stem:'Consider the following statements regarding infertility:\\n1. Endometrial biopsy provides information regarding ovulatory factor\\n2. Both tubal and peritoneal factors can be assessed at laparoscopy\\n3. Unexplained infertility may be due to luteal phase defect\\nWhich of the statements given above is\/are correct?',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'Statement 1 \u2714 \u2014 Endometrial biopsy (secretory phase, day 21\u201326) shows secretory transformation \u2192 confirms ovulation and assesses luteal phase adequacy (luteal phase defect). Statement 2 \u2714 \u2014 Diagnostic LAPAROSCOPY is the gold standard for assessing: tubal patency (via chromopertubation with methylene blue), peritubal\/periovarian adhesions, endometriosis, and other peritoneal factors \u2014 all in one procedure. Statement 3 \u2714 \u2014 Unexplained infertility (normal semen analysis, normal ovulation, normal tubes) may be due to subtle defects including luteal phase deficiency (inadequate progesterone support), subtle endometriosis, sperm-oocyte interaction defects, or immunological factors. All three statements are correct. Answer: 1, 2 and 3.'},\n{id:52,stem:'Which one of the following about primary dysmenorrhoea is NOT true?',correct:'Pain increases following pregnancy and delivery',options:['Confined to adolescent','Always confined to ovulatory cycles','Pain increases following pregnancy and delivery','Pain is related to uterine hypoxia'],exp:'Primary dysmenorrhoea: Confined to adolescents \u2714 (in the sense that it begins at menarche\/adolescence and tends to improve with age; onset always in teens\/young adults). Always in OVULATORY cycles \u2714 \u2014 primary dysmenorrhoea requires ovulation; it only occurs when progesterone primes the endometrium to produce prostaglandins at menstruation; anovulatory cycles are pain-free. Pain related to uterine hypoxia \u2714 \u2014 prostaglandins (PGF2\u03b1, PGE2) cause uterine hypercontractility and vasoconstriction \u2192 ischaemia \u2192 pain (similar to angina mechanism). Pain increases following pregnancy \u2717 \u2014 FALSE. A classic teaching point is that primary dysmenorrhoea typically IMPROVES or RESOLVES after pregnancy and vaginal delivery (cervical dilatation, uterine restructuring). Answer: Pain increases following pregnancy and delivery.'},\n{id:53,stem:'Consider the following statements regarding diameters of a normal female pelvis:\\n1. AP diameter is the shortest diameter at brim\\n2. Oblique diameter is the largest diameter of inlet\\n3. Diagonal conjugate cannot be directly measured\\nWhich of the statements given above is\/are correct?',correct:'1 only',options:['1 and 2 only','1, 2 and 3','1 only','2 only'],exp:'Pelvic inlet diameters: AP (antero-posterior \/ true conjugate = conjugate vera = 11 cm): is the SHORTEST diameter at the pelvic brim \u2714 (statement 1 correct). TRANSVERSE diameter (13.5 cm) is the WIDEST\/LARGEST diameter of the pelvic inlet \u2014 NOT the oblique. Oblique diameter (12.5 cm) is intermediate. Statement 2 \u2717 \u2014 The TRANSVERSE diameter is the largest, not the oblique. Statement 3 \u2717 \u2014 The DIAGONAL conjugate (from pubic symphysis lower border to sacral promontory) IS directly measurable by vaginal examination (approximately 12.5 cm); the TRUE conjugate (obstetric conjugate) cannot be measured directly and is estimated from the diagonal conjugate minus 1.5 cm. Only statement 1 is correct. Answer: 1 only.'},\n{id:54,stem:'Which of the following is NOT a characteristic clinical feature of Bacterial Vaginosis?',correct:'Thick curdy discharge',options:['Vaginal pH \u2265 5','Thick curdy discharge','Amine odour in 10% KOH test','Clue cells'],exp:'Bacterial Vaginosis (BV) \u2014 Amsel\\'s criteria (3 of 4 for diagnosis): Vaginal pH \u22654.5 (>5) \u2714 \u2014 alkaline (loss of Lactobacillus acid production). AMINE (fishy) odour on 10% KOH (Whiff test) \u2714 \u2014 volatile amines released from anaerobes. CLUE CELLS \u2714 \u2014 epithelial cells covered with bacteria (Gardnerella), stippled appearance on wet mount. Thin, white\/grey, homogeneous discharge \u2714 \u2014 NOT thick and curdy. THICK CURDY (cottage cheese) WHITE DISCHARGE \u2717 \u2014 this is the hallmark of CANDIDA (vulvovaginal candidiasis), not BV. BV discharge is thin, grey, and fishy-smelling. Answer: Thick curdy discharge.'},\n{id:55,stem:'Which of the following are the vaccines for prevention of cervical cancer?\\n1. Cervarix\\n2. Gardasil\\n3. T-dap\\n4. Influenza\\nSelect the correct answer:',correct:'1 and 2',options:['1 and 3','2 and 3','1 and 2','2 and 4'],exp:'HPV vaccines for cervical cancer prevention: CERVARIX \u2714 (bivalent: HPV 16 and 18) \u2014 targets the two strains responsible for ~70% of cervical cancers. GARDASIL \u2714 (quadrivalent: HPV 6, 11, 16, 18; or 9-valent: adds 31, 33, 45, 52, 58) \u2014 covers high-risk and low-risk strains. T-dap \u2717 \u2014 Tetanus, diphtheria, acellular pertussis vaccine; completely unrelated to cervical cancer. Influenza \u2717 \u2014 flu vaccine; unrelated to HPV\/cervical cancer. Answer: 1 and 2 (Cervarix and Gardasil).'},\n{id:56,stem:'Consider the following statements regarding Carcinoma Cervix:\\n1. Clinical staging is done\\n2. Treatment if provided in stage I leads to survival rate of 80\u201390%\\n3. Surgery is preferred in young women with stage III disease\\n4. HPV virus is considered to be the causative agent\\nWhich of the statements given above are correct?',correct:'1, 2 and 4 only',options:['1 and 2 only','1, 2 and 4 only','3 and 4 only','1, 2, 3 and 4'],exp:'Statement 1 \u2714 \u2014 Carcinoma cervix uses CLINICAL staging (FIGO); imaging findings can be incorporated per revised 2018 FIGO but clinical examination remains the basis; surgical staging is NOT standard. Statement 2 \u2714 \u2014 Stage I (confined to cervix): 5-year survival 80\u201390% with appropriate treatment (surgery or radiotherapy). Statement 3 \u2717 \u2014 Stage III (extension to pelvic wall\/lower third vagina or hydronephrosis): treatment is CHEMORADIATION (concurrent cisplatin + external beam RT + brachytherapy); surgery is NOT preferred for Stage III as the disease is locally advanced. Surgery preferred in Stage IA\u2013IIA (young women). Statement 4 \u2714 \u2014 HPV (particularly types 16 and 18) is the established causative\/necessary agent in virtually all cervical cancers. Correct: 1, 2 and 4. Answer: 1, 2 and 4 only.'},\n{id:57,stem:'Which one of the following is NOT a mandatory procedure for FIGO staging of Carcinoma cervix?',correct:'Ultrasound abdomen',options:['Pelvic examination','Biopsy','Ultrasound abdomen','Endocervical curettage'],exp:'FIGO staging of carcinoma cervix \u2014 permitted\/mandatory procedures (traditional clinical staging): PELVIC EXAMINATION \u2714 \u2014 mandatory; under anaesthesia for assessment of parametria, pelvic wall, vaginal extension. BIOPSY \u2714 \u2014 histological confirmation is mandatory before staging\/treatment. ENDOCERVICAL CURETTAGE \u2714 \u2014 mandatory to assess endocervical extension (distinguishes stage I from stage II). Other permitted: colposcopy, chest X-ray, IVP, barium enema, cystoscopy, proctoscopy, skeletal X-rays. ULTRASOUND ABDOMEN \u2717 \u2014 NOT a mandatory procedure in traditional FIGO clinical staging; advanced cross-sectional imaging (CT, MRI, PET) findings were not incorporated in earlier FIGO systems (though 2018 revision allows imaging). Answer: Ultrasound abdomen.'},\n{id:58,stem:'Consider the following statements regarding Uterine Leiomyoma:\\n1. Prevalence is highest between 35 and 45 years\\n2. More common in nulliparous women\\n3. Display reversible shrinkage after treatment with GnRH\\n4. Requires to be treated only if symptomatic\\nWhich of the statements given above are correct?',correct:'1, 2, 3 and 4',options:['2 and 3 only','1 and 4 only','1, 2 and 3 only','1, 2, 3 and 4'],exp:'Uterine leiomyoma (fibroid) facts: Statement 1 \u2714 \u2014 prevalence peaks between 35\u201345 years (oestrogen-dependent growth; postmenopausal regression). Statement 2 \u2714 \u2014 more common in nulliparous\/low-parity women; pregnancy has a protective effect (progesterone remodels uterus; fewer cycles of oestrogen stimulation). Statement 3 \u2714 \u2014 GnRH agonists (leuprolide, goserelin) create a hypoestrogenic state \u2192 30\u201360% reduction in fibroid volume; effect is REVERSIBLE (fibroids regrow after stopping therapy); used for 3\u20136 months pre-operatively. Statement 4 \u2714 \u2014 Asymptomatic fibroids do NOT require treatment; intervention only when symptomatic (AUB, pressure symptoms, infertility, recurrent miscarriage) or rapidly growing. All four correct. Answer: 1, 2, 3 and 4.'},\n{id:59,stem:'A 58-year-old woman with suspected ovarian cancer was operated for surgical staging. Both ovaries involved, capsule ruptured, ascites with malignant cells. Uterus and tubes normal, no peritoneal implants. The FIGO stage for this patient would be:',correct:'Stage I',options:['Stage I','Stage II','Stage III','Stage IV'],exp:'FIGO staging of ovarian cancer: Stage I: tumour confined to one or both ovaries. Stage IA: one ovary, intact capsule. Stage IB: both ovaries, intact capsule. Stage IC: one or both ovaries PLUS any of \u2014 surgical spill (IC1), ruptured capsule before surgery (IC2), tumour on ovarian surface or malignant cells in ascites\/peritoneal washings (IC3). Stage II: pelvic extension. Stage III: peritoneal implants beyond pelvis or retroperitoneal nodes. Stage IV: distant metastases. This patient: BOTH ovaries involved + capsule ruptured + malignant cells in ascites. Uterus\/tubes normal, NO peritoneal implants beyond the ovaries. = Stage IC (both ovaries + capsule rupture + malignant ascites). Still STAGE I overall. Answer: Stage I.'},\n{id:60,stem:'Which one of the following is the serum marker in epithelial ovarian cancer?',correct:'CA\u2013125',options:['CA\u2013125','CEA','AFP','HCG'],exp:'Tumour markers in ovarian cancer by histological type: EPITHELIAL ovarian cancer (serous, mucinous, endometrioid, clear cell \u2014 90% of ovarian cancers): CA-125 \u2714 \u2014 elevated in >80% of advanced serous epithelial ovarian cancers; used for diagnosis, monitoring response, and detecting recurrence. CEA: colorectal and mucinous ovarian tumours. AFP: yolk sac tumour (germ cell). hCG: choriocarcinoma, gestational trophoblastic disease. LDH: dysgerminoma. Inhibin: granulosa cell tumour. CA-125 is the PRIMARY marker for epithelial ovarian cancer. Answer: CA-125.'},\n{id:61,stem:'Which one of the following is NOT an ideally suited condition for use of ring pessary in case of uterine prolapse?',correct:'Late pregnancy',options:['Late pregnancy','Puerperium','Patient unfit for surgery','Patient\\'s unwillingness for surgery'],exp:'Ring pessary (Hodge pessary\/ring) for uterine prolapse \u2014 indications: PUERPERIUM \u2714 \u2014 prolapse in early puerperium may resolve with pelvic floor exercises; pessary provides temporary support. UNFIT FOR SURGERY \u2714 \u2014 elderly patients with comorbidities who cannot tolerate general\/spinal anaesthesia. UNWILLINGNESS FOR SURGERY \u2714 \u2014 patient\\'s choice. As temporising measure before surgery \u2714. LATE PREGNANCY \u2717 \u2014 a gravid uterus is bulky and retroverted in early pregnancy but in LATE pregnancy a ring pessary would be physically impossible to position correctly (enlarged uterus fills the pelvis) and would compress pelvic structures; it is NOT an indication. Answer: Late pregnancy.'},\n{id:62,stem:'Labour is called normal if it fulfils following criteria EXCEPT:',correct:'Vaginal breech delivery',options:['Vaginal breech delivery','Vaginal delivery with episiotomy','Vertex presentation','Spontaneous onset at term'],exp:'Criteria for NORMAL labour (WHO\/standard obstetrics): Spontaneous onset at TERM (37\u201342 weeks) \u2714. VERTEX presentation (cephalic \u2014 occiput presenting) \u2714. SPONTANEOUS progress of labour \u2714. Delivery of baby (vaginal) and placenta without undue complications \u2714. Vaginal delivery WITH episiotomy \u2714 \u2014 episiotomy does not disqualify labour from being normal (episiotomy is a minor surgical adjunct). VAGINAL BREECH DELIVERY \u2717 \u2014 breech presentation is an ABNORMAL lie\/presentation; breech labour\/delivery is classified as abnormal\/malpresentation regardless of the vaginal route. Normal labour requires vertex presentation by definition. Answer: Vaginal breech delivery.'},\n{id:63,stem:'Which one of the following methods is NOT used for cervical cancer screening?',correct:'Cervical biopsy',options:['Pap smear','VIA','VILI','Cervical biopsy'],exp:'Cervical cancer SCREENING methods (for asymptomatic women): PAP SMEAR (Papanicolaou) \u2714 \u2014 cytological screening; detects dysplasia. VIA (Visual Inspection with Acetic acid) \u2714 \u2014 acetowhite changes identify CIN; low-resource settings. VILI (Visual Inspection with Lugol\\'s Iodine) \u2714 \u2014 abnormal areas fail to stain (iodine-negative); complementary to VIA. Also: HPV DNA testing, liquid-based cytology. CERVICAL BIOPSY \u2717 \u2014 biopsy is a DIAGNOSTIC procedure, NOT a screening test. Biopsy is performed on a suspicious lesion to confirm histological diagnosis; it cannot be applied to the general asymptomatic population. Screening \u2260 diagnosis. Answer: Cervical biopsy.'},\n{id:64,stem:'Consider the following regarding the use of Magnesium Sulphate:\\n1. Used as tocolytic\\n2. As neuroprotective agent\\n3. Used in management of postpartum eclampsia\\nWhich of the statements given above are correct?',correct:'1, 2 and 3',options:['1 and 2 only','1, 2 and 3','1 and 3 only','2 and 3 only'],exp:'Magnesium sulphate uses in obstetrics: Statement 1 \u2714 \u2014 MgSO\u2084 is used as a TOCOLYTIC (inhibits uterine contractions) to delay preterm labour for 48h (to allow steroid administration and in-utero transfer); though less effective than nifedipine\/atosiban, it is used particularly for neuroprotection simultaneously. Statement 2 \u2714 \u2014 NEUROPROTECTIVE: MgSO\u2084 given to mothers in preterm labour <32 weeks reduces the risk of cerebral palsy in the preterm neonate (ACOG\/RCOG recommendation). Statement 3 \u2714 \u2014 ECLAMPSIA treatment and PREVENTION of recurrent seizures \u2014 both antepartum AND POSTPARTUM eclampsia; Pritchard\/Zuspan regimen used; postpartum seizures can occur up to 48h after delivery and MgSO\u2084 is continued. All three correct. Answer: 1, 2 and 3.'},\n{id:65,stem:'Which one of the following is NOT a common cause of recurrent abortions?',correct:'TORCH group of infections',options:['Maternal diabetes','TORCH group of infections','Antiphospholipid syndrome','Chromosomal abnormality'],exp:'Causes of RECURRENT PREGNANCY LOSS (RPL \u22653 consecutive losses): CHROMOSOMAL ABNORMALITY \u2714 \u2014 parental chromosomal translocations (balanced) account for 3\u20135% RPL; also sporadic aneuploidy. ANTIPHOSPHOLIPID SYNDROME \u2714 \u2014 the most important treatable cause; anticardiolipin antibodies + lupus anticoagulant \u2192 thrombosis of placental vessels \u2192 repeated fetal loss. MATERNAL DIABETES (uncontrolled) \u2714 \u2014 hyperglycaemia \u2192 embryopathy, miscarriage. Also: uterine anomalies, thrombophilias, luteal phase defect, thyroid disorders. TORCH INFECTIONS \u2717 \u2014 TORCH group (Toxoplasma, Rubella, CMV, Herpes) are causes of TERATOGENESIS, stillbirth, and neonatal disease; they are NOT a recognised common cause of RECURRENT abortions (each infection causes sporadic loss, not a pattern of recurrence). Answer: TORCH group of infections.'},\n{id:66,stem:'Contraindications to Uterine Cerclage for Incompetent os are all EXCEPT:',correct:'Previous history suggestive of abortion due to incompetent os',options:['Previous history suggestive of abortion due to incompetent os','Ruptured membrane','Bulging membrane','History of vaginal bleeding'],exp:'Cervical cerclage \u2014 contraindications: RUPTURED MEMBRANES \u2714 \u2014 procedure risks infection\/cord prolapse. BULGING MEMBRANES \u2714 \u2014 technically difficult, risk of membrane rupture during insertion (relative contraindication; some centres attempt with special precautions). VAGINAL BLEEDING \u2714 \u2014 suggests threatened abortion; inserting cerclage in this setting may exacerbate loss. Active infection (chorioamnionitis) \u2714. Major fetal anomalies \u2714. PREVIOUS HISTORY of abortion due to incompetent os \u2717 \u2014 this is the PRIMARY INDICATION for cerclage, NOT a contraindication. A history of mid-trimester losses with painless cervical dilatation is exactly what elective cerclage is performed for. Answer: Previous history suggestive of abortion due to incompetent os.'},\n{id:67,stem:'The most common cause of early spontaneous abortion is:',correct:'Chromosomal abnormality',options:['Chromosomal abnormality','Infection','Endocrine disorder','Teratogens'],exp:'Early spontaneous abortion (first trimester, <12 weeks) \u2014 aetiology: CHROMOSOMAL ABNORMALITY \u2714 \u2014 accounts for ~50\u201360% of all first-trimester spontaneous abortions. Most common: Autosomal trisomy (~52%), especially trisomy 16; monosomy X (45,X) ~19%; triploidy ~16%. This chromosomal error is overwhelmingly the most frequent cause. Infection: rarely causes isolated early sporadic abortion. Endocrine (progesterone deficiency, thyroid): more relevant for RECURRENT losses. Teratogens: cause anomalies; may contribute to abortion but not the most common cause. Answer: Chromosomal abnormality.'},\n{id:68,stem:'Cause of Fetal growth restriction may be:\\n1. Chromosomal abnormality\\n2. Congenital abnormality\\n3. Abnormal cord insertion\\nWhich of the statements given above is\/are correct?',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1, 2 and 3','1 and 3 only'],exp:'Causes of Fetal Growth Restriction (FGR): FETAL factors: Chromosomal abnormalities \u2714 (trisomies 13, 18, 21; Turner syndrome) \u2014 intrinsically small fetuses. Congenital abnormalities \u2714 (structural defects, congenital infections \u2014 TORCH). PLACENTAL factors: Abnormal cord insertion \u2714 \u2014 velamentous or marginal cord insertion \u2192 impaired nutrient transfer \u2192 FGR. Also: placental abruption, placenta praevia, circumvallate placenta, infarcts. MATERNAL factors: hypertension, malnutrition, smoking, drugs, alcohol. All three stated causes (chromosomal, congenital, cord insertion) are valid. Answer: 1, 2 and 3.'},\n{id:69,stem:'Which one of the following regarding fetal growth restriction is NOT true?',correct:'Delivery always at 34 weeks',options:['Daily fetal movement count is advised','Biophysical profile is done','Delivery always at 34 weeks','Umbilical artery Doppler studies are done'],exp:'Fetal Growth Restriction management: DAILY FETAL MOVEMENT COUNT \u2714 \u2014 kick charts are advised; decreased movements trigger further assessment. BIOPHYSICAL PROFILE \u2714 \u2014 BPP (NST + 4 ultrasound parameters) quantifies fetal wellbeing. UMBILICAL ARTERY DOPPLER \u2714 \u2014 gold standard surveillance in FGR; absent\/reversed end-diastolic flow indicates severe compromise and guides delivery timing. DELIVERY ALWAYS AT 34 WEEKS \u2717 \u2014 FALSE. Delivery timing in FGR is INDIVIDUALISED based on: severity of Doppler abnormality, BPP score, CTG findings, gestational age. Absent EDF \u2192 deliver ~34 weeks; reversed EDF \u2192 deliver earlier (~30\u201332 weeks; sometimes sooner). Mild FGR with normal Doppler may be monitored to 37+ weeks. \"Always at 34 weeks\" is incorrect. Answer: Delivery always at 34 weeks.'},\n{id:70,stem:'Which one of the following statements regarding contraception is NOT true?',correct:'Vaginal ring is a barrier method',options:['Vaginal ring is a barrier method','Implanon is a hormonal contraceptive','Copper T can be used as post coital contraception','Copper T can be inserted just after delivery'],exp:'Vaginal ring (NuvaRing) \u2717 \u2014 NOT a barrier method. It is a COMBINED HORMONAL contraceptive device: releases etonogestrel + ethinylestradiol locally; works by inhibiting ovulation, thickening cervical mucus. Barrier methods = condoms, diaphragm, cervical cap. Implanon \u2714 \u2014 a single-rod subdermal implant releasing etonogestrel; hormonal contraceptive. Copper T as post-coital contraception \u2714 \u2014 Copper IUD inserted within 5 days of unprotected intercourse is the most effective emergency contraception (>99% effective). Copper T just after delivery \u2714 \u2014 POST-PLACENTAL insertion (within 10 minutes of placenta delivery) is safe, highly effective, and recommended. Answer: Vaginal ring is a barrier method.'},\n{id:71,stem:'A 26-year-old P2L2 has just had delivery. What are the contraceptive choices she has at present?\\n1. Post placental insertion of IUCD\\n2. Post partum ligation\\n3. Oral contraceptive pill\\n4. Lap ligation\\nSelect the correct answer:',correct:'1 and 2 only',options:['1 and 2 only','1, 2 and 4','2 only','1 and 3'],exp:'Immediate post-delivery contraception options: POST-PLACENTAL IUCD \u2714 (option 1) \u2014 inserted within 10 minutes of placental delivery; safe, effective, highly recommended in India under FP-LMIS programme. POST-PARTUM LIGATION \u2714 (option 2) \u2014 mini-laparotomy (Pomeroy\\'s technique) within 48h of delivery while the uterus is still elevated; recommended for women who have completed family. ORAL CONTRACEPTIVE PILL \u2717 (option 3) \u2014 COMBINED OCP is contraindicated in the immediate postpartum period if breastfeeding (oestrogen suppresses lactation; WHO Category 4 <6 weeks postpartum while breastfeeding). LAPAROSCOPIC LIGATION \u2717 (option 4) \u2014 laparoscopy is technically difficult immediately postpartum (enlarged uterus, distorted anatomy); not performed at this time (done after 6 weeks). Correct: 1 and 2. Answer: 1 and 2 only.'},\n{id:72,stem:'A 22-year-old woman presents with pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium minus, overlying skin is red and oedematous. What is the most probable diagnosis?',correct:'Bartholin\\'s abscess',options:['Utero vaginal prolapse','Inversion of uterus','Bartholin\\'s abscess','Trichomoniasis'],exp:'BARTHOLIN\\'S ABSCESS: Bartholin\\'s gland duct blockage \u2192 cyst \u2192 secondary infection \u2192 abscess. Classic features \u2714: UNILATERAL (glands are paired, one side affected), tender swelling in the POSTERIOR HALF of the labium majus\/minus (Bartholin\\'s gland lies in posterior labia), overlying skin RED and OEDEMATOUS (acute inflammation), pain and dyspareunia. Uterovaginal prolapse: descent of uterus\/vaginal walls; no acute swelling. Uterine inversion: obstetric emergency; uterus inverts through cervix. Trichomoniasis: diffuse vaginal discharge, no localised labial swelling. Unilateral posterior labial swelling + tenderness = Bartholin\\'s abscess. Answer: Bartholin\\'s abscess.'},\n{id:73,stem:'A 29-year-old woman has three consecutive first trimester spontaneous abortions. Examination reveals fibroid uterus. Which of the following types of uterine fibroids would most likely lead to recurrent abortions?',correct:'Submucosal',options:['Submucosal','Intramural','Subserosal','Cervical'],exp:'Fibroids and recurrent miscarriage \u2014 relationship by location: SUBMUCOSAL \u2714 \u2014 projects into the ENDOMETRIAL CAVITY; directly distorts the uterine cavity; impairs endometrial blood flow and implantation; causes decidual changes making the local environment hostile for the embryo. Most closely associated with recurrent miscarriage and infertility. INTRAMURAL \u2014 large intramural fibroids may distort the cavity and cause abortion but less directly. SUBSEROSAL \u2014 projects outward; no impact on endometrial cavity; does NOT cause recurrent abortion. CERVICAL \u2014 rare; may obstruct cervix but not the primary cause of recurrent first-trimester loss. Submucosal fibroid is the type most causally linked to recurrent abortion. Answer: Submucosal.'},\n{id:74,stem:'A 25-year-old infertile woman is noted to have blocked fallopian tube on Hysterosalpingography. Which of the following is the best next step for this woman?',correct:'Laparoscopy',options:['Clomiphene citrate therapy','Gonadotropin therapy','Laparoscopy','Intrauterine insemination'],exp:'Blocked fallopian tube on HSG: HSG is a screening\/first-line investigation. A single HSG showing tubal block can be due to: cornual spasm (false positive, ~15\u201320%), true proximal occlusion, distal hydrosalpinx, or peritubal adhesions. LAPAROSCOPY \u2714 \u2014 is the GOLD STANDARD next step to: (1) confirm or refute HSG findings, (2) assess extent of tubal disease, peritubal adhesions, endometriosis, (3) attempt surgical correction (salpingolysis, salpingostomy). Chromopertubation at laparoscopy confirms patency. Clomiphene\/gonadotropins: for ovulation induction \u2014 irrelevant if tubes are blocked. IUI: requires at least ONE patent tube \u2014 contraindicated if both blocked. Answer: Laparoscopy.'},\n{id:75,stem:'The contraceptive choice for a 38-year-old woman with chronic hypertension and history of dysmenorrhoea and menorrhagia (malignancy ruled out) is:',correct:'Levonorgestrel intrauterine device',options:['Copper intrauterine device','Levonorgestrel intrauterine device','Combined oral contraceptive pills','Sterilization'],exp:'This patient has: HYPERTENSION (chronic) + DYSMENORRHOEA + MENORRHAGIA. LEVONORGESTREL-IUD (Mirena) \u2714: locally delivers progestogen \u2192 endometrial atrophy \u2192 significantly reduces menstrual bleeding (treats menorrhagia) and dysmenorrhoea; highly effective contraception (>99%); no systemic oestrogen \u2192 SAFE in hypertension (WHO Category 1); lasts 5 years. COPPER IUD \u2717 \u2014 worsens dysmenorrhoea and menorrhagia; inappropriate here. COMBINED OCP \u2717 \u2014 contraindicated in women \u226535 years with hypertension (WHO Category 3\u20134); oestrogen raises BP and thrombotic risk. STERILISATION \u2717 \u2014 permanent; premature at 38 unless family is complete; does not address the menstrual symptoms. LNG-IUS perfectly addresses all three issues. Answer: Levonorgestrel intrauterine device.'},\n{id:76,stem:'Which one of the following drugs does NOT interfere with efficacy of oral contraceptive pills and increase the failure rates?',correct:'Ranitidine',options:['Ranitidine','Rifampicin','Ampicillin','Barbiturates'],exp:'Drugs reducing OCP efficacy (enzyme INDUCERS of CYP450 \u2192 accelerate oestrogen\/progestogen metabolism): RIFAMPICIN \u2714 \u2014 potent CYP3A4 inducer; most significant interaction; dramatically reduces contraceptive levels; additional contraception always required. BARBITURATES \u2714 \u2014 phenobarbitone is a CYP inducer; reduces OCP levels. AMPICILLIN \u2714 \u2014 disrupts enterohepatic recirculation of oestrogen by killing gut bacteria \u2192 reduces oestrogen reabsorption (though evidence is debated, it is classically listed). RANITIDINE \u2717 \u2014 H\u2082 blocker (anti-ulcer); does NOT induce CYP450 enzymes; does NOT affect OCP metabolism or efficacy. Answer: Ranitidine.'},\n{id:77,stem:'Which one of the following antihypertensive drugs is NOT safe during pregnancy?',correct:'ACE-inhibitors',options:['Labetalol','ACE-inhibitors','Alpha-methyl dopa','Nifedipine'],exp:'Antihypertensives in pregnancy \u2014 safety: ALPHA-METHYLDOPA \u2714 \u2014 drug of choice in pregnancy; longest safety record; central alpha-2 agonist; safe for fetus. LABETALOL \u2714 \u2014 alpha + beta blocker; safe and widely used in hypertensive emergencies of pregnancy (IV labetalol). NIFEDIPINE \u2714 \u2014 calcium channel blocker; used for acute severe hypertension and as tocolytic; safe. ACE INHIBITORS \u2717 \u2014 CONTRAINDICATED in pregnancy (ALL trimesters, especially 2nd and 3rd trimester). ACE inhibitors cause: fetal renal tubular dysgenesis, oligohydramnios, pulmonary hypoplasia, neonatal renal failure, skull ossification defects, IUGR, and fetal death. WHO Category X equivalent. Answer: ACE-inhibitors.'},\n{id:78,stem:'Tubectomy is commonly performed at which site of fallopian tube?',correct:'Isthmus',options:['Ampulla','Infundibulum','Isthmus','Cornua'],exp:'Tubectomy (female sterilisation) \u2014 site of tubal occlusion: ISTHMUS \u2714 \u2014 the most common site for tubectomy using the POMEROY technique (loop of isthmus ligated and excised) and modified Pomeroy. Reasons: isthmus is the narrowest, most accessible part; has the thickest muscular wall; easy to identify; adequate length of tube to ligate and excise; cornual end remains patent but ovum cannot traverse. AMPULLA \u2014 used in salpingectomy for ectopic but not standard tubectomy site. INFUNDIBULUM\/FIMBRIA \u2014 fimbriectomy is an older technique, now rarely used. CORNUA \u2014 cornual resection is a hysteroscopic technique for permanent sterilisation but not standard open tubectomy. Answer: Isthmus.'},\n{id:79,stem:'A 60-year-old woman presents with postmenopausal bleeding. On endometrial curettage she is diagnosed as endometrial carcinoma. Which one of the following is a risk factor for endometrial cancer?',correct:'Diabetes mellitus',options:['Multiparity','Oral contraceptive use','Smoking','Diabetes mellitus'],exp:'Endometrial carcinoma risk factors (oestrogen excess\/metabolic): DIABETES MELLITUS \u2714 \u2014 insulin resistance \u2192 hyperinsulinaemia \u2192 increased ovarian androgen \u2192 peripheral conversion to oestrone \u2192 endometrial stimulation; 2\u20133\u00d7 risk increase. Other risk factors: obesity, nulliparity\/low parity, early menarche\/late menopause, unopposed oestrogen therapy, tamoxifen use, Lynch syndrome. MULTIPARITY \u2717 \u2014 PROTECTIVE; progesterone during pregnancy opposes endometrial stimulation. OCP USE \u2717 \u2014 PROTECTIVE; combined OCP (progestogen component) reduces risk by 50%. SMOKING \u2717 \u2014 paradoxically PROTECTIVE (anti-oestrogenic effect of smoking); but this does not mean smoking is recommended. Answer: Diabetes mellitus.'},\n{id:80,stem:'A 29-year-old woman presents with amenorrhoea of 6 weeks and pain. Urine pregnancy test positive. Diffuse lower abdominal tenderness, guarding. Beta-hCG = 4000 mIU\/ml. Transvaginal ultrasound shows no pregnancy in uterus, no adnexal mass, but moderate fluid in abdomen. What is the next best step?',correct:'Emergency laparotomy',options:['Repeat Beta-hCG level in 48 hours','Institution of methotrexate','Emergency laparotomy','Wait and watch'],exp:'This presentation is a RUPTURED ECTOPIC PREGNANCY with haemoperitoneum until proven otherwise: Positive UPT + 6 weeks amenorrhoea \u2714. No intrauterine pregnancy on TVS \u2714. MODERATE FREE FLUID IN ABDOMEN \u2714 \u2014 haemoperitoneum (ruptured ectopic). PERITONEAL SIGNS \u2014 diffuse tenderness + guarding \u2714 \u2014 indicating significant intraperitoneal haemorrhage with peritoneal irritation. This patient is HAEMODYNAMICALLY compromised or imminently so. EMERGENCY LAPAROTOMY \u2714 \u2014 the ONLY correct step; immediate surgical intervention to control haemorrhage (salpingectomy). Methotrexate \u2717 \u2014 contraindicated when there is rupture\/haemoperitoneum\/haemodynamic instability. Repeat beta-hCG or wait-and-watch \u2717 \u2014 dangerous delays when patient has signs of haemoperitoneum. Answer: Emergency laparotomy.'}\n];\n\nfunction shuffle(a){var b=[].concat(a);for(var i=b.length-1;i>0;i--){var j=Math.floor(Math.random()*(i+1));var t=b[i];b[i]=b[j];b[j]=t;}return b;}\nvar L=['A','B','C','D'];\nvar ua={},ans=0,so={},sub=false,tr=false,rem=TSECS,ti=null,gi=null;\n\nfunction fmt(s){var m=Math.floor(s\/60),x=s%60;return(''+m).padStart(2,'0')+':'+(''+x).padStart(2,'0');}\n\nfunction startTimer(){\n if(tr||sub)return;tr=true;\n var btn=document.getElementById(NS+'-tbtn');btn.textContent='\u23f1 '+fmt(rem);btn.classList.add('run');\n document.getElementById(NS+'-ti').classList.add('on');\n ti=setInterval(function(){\n rem--;var d=fmt(rem);document.getElementById(NS+'-td').textContent=d;btn.textContent='\u23f1 '+d;\n if(rem<=300)document.getElementById(NS+'-ti').classList.add('warn');\n if(rem<=0){clearInterval(ti);ti=null;grace();}\n },1000);\n}\nfunction stopTimer(){if(ti){clearInterval(ti);ti=null;}tr=false;}\nfunction grace(){\n if(sub)return;var g=GSECS;document.getElementById(NS+'-gc').textContent=g;document.getElementById(NS+'-grace').classList.add('show');\n gi=setInterval(function(){g--;document.getElementById(NS+'-gc').textContent=g;if(g<=0){clearInterval(gi);gi=null;hideGrace();showScore();}},1000);\n}\nfunction hideGrace(){document.getElementById(NS+'-grace').classList.remove('show');if(gi){clearInterval(gi);gi=null;}}\n\nfunction build(){\n var c=document.getElementById(NS+'-qs');c.innerHTML='';ua={};ans=0;so={};sub=false;tr=false;rem=TSECS;\n stopTimer();if(gi){clearInterval(gi);gi=null;}hideGrace();\n document.getElementById(NS+'-sc-box').style.display='none';\n document.getElementById(NS+'-ti').classList.remove('on','warn');\n var btn=document.getElementById(NS+'-tbtn');btn.textContent='\u23f1 Start Timed Mode';btn.classList.remove('run');\n document.getElementById(NS+'-td').textContent=fmt(TSECS);\n stats();\n QS.forEach(function(q){\n var opts=shuffle(q.options);so[q.id]=opts;\n var d=document.createElement('div');d.className='card';\n d.innerHTML='<div class=\"qh\"><div class=\"qn\" id=\"'+NS+'-qn'+q.id+'\">'+q.id+'<\/div><div class=\"qt\">'+q.stem.replace(\/\\n\/g,'<br>')+'<\/div><\/div>'+\n '<div class=\"opts\" id=\"'+NS+'-op'+q.id+'\">'+\n opts.map(function(o,i){return '<div class=\"opt\" id=\"'+NS+'-o'+q.id+'_'+i+'\" role=\"button\" tabindex=\"0\"><span class=\"ol\">'+L[i]+'<\/span><span class=\"ot\">'+o+'<\/span><\/div>';}).join('')+\n '<\/div><div class=\"exp\" id=\"'+NS+'-ex'+q.id+'\"><div class=\"exl\">Explanation<\/div>'+q.exp+'<\/div>';\n c.appendChild(d);\n opts.forEach(function(_,i){document.getElementById(NS+'-o'+q.id+'_'+i).addEventListener('click',function(){pick(q.id,i);});});\n });\n}\n\nfunction pick(qid,oi){\n if(ua[qid]!==undefined||sub)return;\n var q=QS.find(function(x){return x.id===qid;});\n var opts=so[qid];var ok=opts[oi]===q.correct;\n ua[qid]=ok?'c':'w';ans++;\n opts.forEach(function(o,i){\n var el=document.getElementById(NS+'-o'+qid+'_'+i);\n if(o===q.correct)el.classList.add('co','lk');\n else if(i===oi)el.classList.add('wr','lk');\n else el.classList.add('dm','lk');\n });\n document.getElementById(NS+'-qn'+qid).classList.add(ok?'c':'w');\n document.getElementById(NS+'-ex'+qid).style.display='block';\n stats();\n}\n\nfunction stats(){\n var c=Object.values(ua).filter(function(v){return v==='c';}).length;\n var w=Object.values(ua).filter(function(v){return v==='w';}).length;\n var net=c*4-w;\n document.getElementById(NS+'-sc').textContent=c;\n document.getElementById(NS+'-sw').textContent=w;\n document.getElementById(NS+'-sr').textContent=TOTAL-ans;\n document.getElementById(NS+'-sn').textContent=net>0?'+'+net:net;\n document.getElementById(NS+'-sm').textContent=MAX;\n document.getElementById(NS+'-fill').style.width=(ans\/TOTAL*100)+'%';\n}\n\nfunction showScore(){\n if(sub)return;sub=true;stopTimer();\n document.getElementById(NS+'-tbtn').textContent='\u23f1 Submitted';\n document.getElementById(NS+'-tbtn').classList.remove('run');\n var c=Object.values(ua).filter(function(v){return v==='c';}).length;\n var w=Object.values(ua).filter(function(v){return v==='w';}).length;\n var sk=TOTAL-ans,net=c*4-w;\n var pct=Math.max(0,Math.round(net\/MAX*100));\n var d=Math.min(100,Math.max(0,pct));\n document.getElementById(NS+'-ring').style.background='conic-gradient(var(--teal) '+d+'%,var(--line) 0%)';\n document.getElementById(NS+'-rp').textContent=pct+'%';\n document.getElementById(NS+'-nl').textContent='Net Score: '+net+' \/ '+MAX;\n var v=pct>=80?'Excellent \u2014 well above the qualifying threshold.':pct>=60?'Good attempt \u2014 consolidate the weaker areas.':pct>=40?'Fair \u2014 systematic revision recommended.':'Needs significant revision across these topics.';\n document.getElementById(NS+'-vd').textContent=v;\n document.getElementById(NS+'-bc').textContent='\u2705 '+c+' Correct';\n document.getElementById(NS+'-bw').textContent='\u274c '+w+' Wrong';\n document.getElementById(NS+'-bs').textContent='\u23ed '+sk+' Skipped';\n var sc=document.getElementById(NS+'-sc-box');sc.style.display='block';sc.scrollIntoView({behavior:'smooth',block:'center'});\n}\n\nfunction init(){\n document.getElementById(NS+'-gnow').addEventListener('click',function(){hideGrace();showScore();});\n document.getElementById(NS+'-tbtn').addEventListener('click',function(){if(!tr&&!sub)startTimer();});\n document.getElementById(NS+'-sub').addEventListener('click',showScore);\n document.getElementById(NS+'-retry').addEventListener('click',function(){build();window.scrollTo({top:0,behavior:'smooth'});});\n new IntersectionObserver(function(e){document.getElementById(NS+'-sb').classList.toggle('vis',!e[0].isIntersecting);},{threshold:0}).observe(document.getElementById(NS+'-sen'));\n build();stats();\n}\nif(document.readyState==='loading'){document.addEventListener('DOMContentLoaded',init);}else{init();}\n})();\n<\/script>\n<\/body>\n<\/html>\n\n\n","protected":false},"excerpt":{"rendered":"<p>CMS 2019 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2019Paper 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-36827","post","type-post","status-publish","format-standard","hentry","category-cms","category-obg"],"yoast_head":"\n<title>CMS 2019 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\/13\/cms-2019-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 2019 P2 Part-B OBG - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2019 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2019Paper 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\" \/>\n<meta property=\"og:url\" content=\"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/\" \/>\n<meta property=\"og:site_name\" content=\"atsixty\" \/>\n<meta property=\"article:published_time\" content=\"2026-05-13T04:44:21+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-05-13T04:44:43+00:00\" \/>\n<meta name=\"author\" content=\"Avi\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Avi\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\"},\"author\":{\"name\":\"Avi\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"headline\":\"CMS 2019 P2 Part-B OBG\",\"datePublished\":\"2026-05-13T04:44:21+00:00\",\"dateModified\":\"2026-05-13T04:44:43+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\"},\"wordCount\":54,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"articleSection\":[\"CMS\",\"OBG\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\",\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\",\"name\":\"CMS 2019 P2 Part-B OBG - atsixty\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\"},\"datePublished\":\"2026-05-13T04:44:21+00:00\",\"dateModified\":\"2026-05-13T04:44:43+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/atsixty.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"CMS 2019 P2 Part-B OBG\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\",\"url\":\"https:\\\/\\\/atsixty.com\\\/\",\"name\":\"At Sixty\",\"description\":\"The Option Taken\",\"publisher\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/atsixty.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\",\"name\":\"Avi\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"url\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"contentUrl\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"width\":200,\"height\":200,\"caption\":\"Avi\"},\"logo\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\"},\"sameAs\":[\"https:\\\/\\\/atsixty.com\"],\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/author\\\/avinaux\\\/\"}]}<\/script>\n","yoast_head_json":{"title":"CMS 2019 P2 Part-B OBG - atsixty","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/","og_locale":"en_US","og_type":"article","og_title":"CMS 2019 P2 Part-B OBG - atsixty","og_description":"CMS 2019 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2019Paper 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","og_url":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/","og_site_name":"atsixty","article_published_time":"2026-05-13T04:44:21+00:00","article_modified_time":"2026-05-13T04:44:43+00:00","author":"Avi","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Avi","Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/#article","isPartOf":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/"},"author":{"name":"Avi","@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"headline":"CMS 2019 P2 Part-B OBG","datePublished":"2026-05-13T04:44:21+00:00","dateModified":"2026-05-13T04:44:43+00:00","mainEntityOfPage":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/"},"wordCount":54,"commentCount":0,"publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"articleSection":["CMS","OBG"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/","url":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/","name":"CMS 2019 P2 Part-B OBG - atsixty","isPartOf":{"@id":"https:\/\/atsixty.com\/#website"},"datePublished":"2026-05-13T04:44:21+00:00","dateModified":"2026-05-13T04:44:43+00:00","breadcrumb":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/atsixty.com\/"},{"@type":"ListItem","position":2,"name":"CMS 2019 P2 Part-B OBG"}]},{"@type":"WebSite","@id":"https:\/\/atsixty.com\/#website","url":"https:\/\/atsixty.com\/","name":"At Sixty","description":"The Option Taken","publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/atsixty.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d","name":"Avi","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","url":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","contentUrl":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","width":200,"height":200,"caption":"Avi"},"logo":{"@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png"},"sameAs":["https:\/\/atsixty.com"],"url":"https:\/\/atsixty.com\/index.php\/author\/avinaux\/"}]}},"_links":{"self":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36827","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/comments?post=36827"}],"version-history":[{"count":1,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36827\/revisions"}],"predecessor-version":[{"id":36828,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36827\/revisions\/36828"}],"wp:attachment":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/media?parent=36827"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/categories?post=36827"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/tags?post=36827"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}

{"id":36827,"date":"2026-05-13T10:14:21","date_gmt":"2026-05-13T04:44:21","guid":{"rendered":"https:\/\/atsixty.com\/?p=36827"},"modified":"2026-05-13T10:14:43","modified_gmt":"2026-05-13T04:44:43","slug":"cms-2019-p2-part-b-obg","status":"publish","type":"post","link":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/","title":{"rendered":"CMS 2019 P2 Part-B OBG"},"content":{"rendered":"\n\n\n\n\n\n\n\nCMS 2019 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#cms19p2b*,#cms19p2b *::before,#cms19p2b *::after{box-sizing:border-box;margin:0;padding:0}\n#cms19p2b{--ter:#C0603A;--ter-pale:#fdf1ec;--teal:#2A7A6F;--teal-light:#3da394;--teal-pale:#eaf4f3;--ink:#1a1a1a;--ink-mid:#444;--ink-soft:#777;--line:#e0d8d4;--bg:#fdfaf8;--white:#fff;--cb:#43a047;--cb-bg:#eaf7ef;--wb:#e53935;--wb-bg:#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#cms19p2b .sen{height:1px}\n#cms19p2b .sb{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,.11);opacity:0;pointer-events:none;transform:translateY(-110%);transition:opacity .22s,transform .22s}\n#cms19p2b .sb.vis{opacity:1;pointer-events:auto;transform:translateY(0)}\n#cms19p2b .sb-row{display:flex;align-items:center;padding:.38rem .7rem;font-size:.73rem;color:var(--ink-soft)}\n#cms19p2b .sb-it{display:flex;align-items:center;gap:.18rem;padding:.1rem .5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1}\n#cms19p2b .sb-it:last-child{border-right:none}\n#cms19p2b .sb-it strong{color:var(--ink);font-size:.8rem;font-weight:700}\n#cms19p2b .sb-sep{flex:1}\n#cms19p2b .sb-bar{height:4px;background:var(--line);overflow:hidden}\n#cms19p2b .sb-fill{height:100%;background:linear-gradient(90deg,var(--ter),var(--teal));width:0%;transition:width .4s}\n#cms19p2b .ti{display:none;align-items:center;gap:.18rem;padding:.1rem .5rem;border-right:1px solid var(--line);white-space:nowrap;line-height:1;font-size:.73rem}\n#cms19p2b .ti.on{display:flex}\n#cms19p2b .ti strong{font-size:.8rem;font-weight:700;color:var(--teal);font-variant-numeric:tabular-nums}\n#cms19p2b .ti.warn strong{color:var(--wb)}\n#cms19p2b .grace{display:none;position:fixed;inset:0;z-index:999999;background:rgba(0,0,0,.55);align-items:center;justify-content:center}\n#cms19p2b .grace.show{display:flex}\n#cms19p2b .gb{background:var(--white);border-radius:12px;border-top:5px solid var(--wb);padding:32px 28px;text-align:center;max-width:320px;width:90%;box-shadow:0 8px 40px rgba(0,0,0,.25)}\n#cms19p2b .gb h3{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--wb);margin-bottom:10px}\n#cms19p2b .gb p{font-size:.88rem;color:var(--ink-mid);margin-bottom:18px;line-height:1.55}\n#cms19p2b .gc{font-family:'Playfair Display',serif;font-size:2.8rem;font-weight:700;color:var(--wb);line-height:1;margin-bottom:18px}\n#cms19p2b .gnow{background:var(--wb);color:#fff;border:none;border-radius:8px;padding:10px 24px;font-family:'Playfair Display',serif;font-size:.95rem;font-weight:700;cursor:pointer}\n#cms19p2b .hdr{background:var(--teal);color:var(--white);padding:28px 24px 22px;text-align:center}\n#cms19p2b .hdr h1{font-family:'Playfair Display',serif;font-size:1.45rem;font-weight:700;line-height:1.3}\n#cms19p2b .hdr p{font-size:.85rem;opacity:.85;margin-top:6px;font-style:italic}\n#cms19p2b .meta{display:flex;justify-content:center;gap:16px;margin-top:14px;flex-wrap:wrap;align-items:center}\n#cms19p2b .bdg{background:rgba(255,255,255,.15);border:1px solid rgba(255,255,255,.3);border-radius:20px;padding:4px 14px;font-size:.78rem}\n#cms19p2b .tbtn{background:transparent;border:1.5px solid rgba(255,255,255,.7);color:var(--white);border-radius:20px;padding:4px 14px;font-family:'Source Serif 4',serif;font-size:.78rem;cursor:pointer;transition:background .2s}\n#cms19p2b .tbtn:hover{background:rgba(255,255,255,.15)}\n#cms19p2b .tbtn.run{background:rgba(255,255,255,.2);border-color:var(--white)}\n#cms19p2b .body{max-width:760px;margin:0 auto;padding:0 16px}\n#cms19p2b .card{background:var(--white);border:1px solid var(--line);border-radius:var(--r);margin:24px 0;overflow:hidden;transition:box-shadow .2s}\n#cms19p2b .card:hover{box-shadow:0 2px 12px rgba(192,96,58,.1)}\n#cms19p2b .qh{background:var(--ter-pale);border-bottom:1px solid var(--line);padding:14px 18px;display:flex;gap:12px;align-items:flex-start}\n#cms19p2b .qn{flex-shrink:0;width:26px;height:26px;border-radius:50%;background:var(--ter);color:#fff;font-size:.72rem;font-weight:700;display:flex;align-items:center;justify-content:center;margin-top:2px;transition:background .2s}\n#cms19p2b .qn.c{background:var(--cb)}\n#cms19p2b .qn.w{background:var(--wb)}\n#cms19p2b .qt{font-size:.93rem;color:var(--ink);line-height:1.65}\n#cms19p2b .opts{padding:14px 18px;display:flex;flex-direction:column;gap:8px}\n#cms19p2b .opt{display:flex;align-items:flex-start;gap:10px;padding:10px 14px;border:1.5px solid var(--line);border-radius:8px;cursor:pointer;transition:border-color .15s,background .15s;background:var(--white);-webkit-tap-highlight-color:transparent}\n#cms19p2b .opt:hover:not(.lk){border-color:var(--teal);background:var(--teal-pale)}\n#cms19p2b .ol{flex-shrink:0;width:20px;height:20px;border-radius:50%;border:1.5px solid var(--line);display:flex;align-items:center;justify-content:center;font-size:.65rem;font-weight:700;color:var(--ink-soft);margin-top:1px;transition:all .15s}\n#cms19p2b .ot{font-size:.89rem;color:var(--ink-mid);line-height:1.55}\n#cms19p2b .opt.co{border-color:var(--cb);background:var(--cb-bg);cursor:default}\n#cms19p2b .opt.co .ol{background:var(--cb);border-color:var(--cb);color:#fff}\n#cms19p2b .opt.co .ot{color:#1e6f46;font-weight:600}\n#cms19p2b .opt.wr{border-color:var(--wb);background:var(--wb-bg);cursor:default}\n#cms19p2b .opt.wr .ol{background:var(--wb);border-color:var(--wb);color:#fff}\n#cms19p2b .opt.wr .ot{color:var(--wb)}\n#cms19p2b .opt.dm{opacity:.42;cursor:default}\n#cms19p2b .opt.lk{cursor:default}\n#cms19p2b .exp{display:none;background:var(--teal-pale);border-top:1px solid #b2d8d3;padding:10px 18px 12px;font-size:.82rem;color:#1a4f49;line-height:1.62}\n#cms19p2b .exl{font-size:.7rem;font-weight:700;letter-spacing:.08em;text-transform:uppercase;color:var(--teal);margin-bottom:4px}\n#cms19p2b .sw{text-align:center;padding:28px 16px 8px}\n#cms19p2b .btn{background:var(--teal);color:var(--white);border:none;border-radius:8px;padding:13px 36px;font-family:'Playfair Display',serif;font-size:1rem;font-weight:700;cursor:pointer;transition:background .2s,transform .1s}\n#cms19p2b .btn:hover{background:var(--teal-light)}\n#cms19p2b .btn:active{transform:scale(.98)}\n#cms19p2b .sc{display:none;background:var(--white);border:2px solid var(--teal);border-radius:var(--r);margin:28px 0 0;padding:28px 24px;text-align:center}\n#cms19p2b .ring{width:110px;height:110px;border-radius:50%;background:conic-gradient(var(--teal) 0%,var(--line) 0%);display:flex;align-items:center;justify-content:center;margin:0 auto 20px;position:relative}\n#cms19p2b .ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms19p2b .ri{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms19p2b .rp{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms19p2b .rs{font-size:.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:.05em}\n#cms19p2b .sc h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms19p2b .nl{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms19p2b .vd{font-size:.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms19p2b .bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:.8rem}\n#cms19p2b .band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms19p2b .bc{background:var(--cb-bg);color:#1e6f46}\n#cms19p2b .bw{background:var(--wb-bg);color:var(--wb)}\n#cms19p2b .bs{background:var(--teal-pale);color:var(--teal)}\n#cms19p2b .rbtn{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:.95rem;font-weight:700;cursor:pointer;transition:background .2s,color .2s}\n#cms19p2b .rbtn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){#cms19p2b .hdr h1{font-size:1.15rem}#cms19p2b .qt{font-size:.88rem}#cms19p2b .ot{font-size:.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms19p2b\">\n<div class=\"sen\" id=\"cms19p2b-sen\"><\/div>\n<div class=\"sb\" id=\"cms19p2b-sb\">\n <div class=\"sb-row\">\n <div class=\"ti\" id=\"cms19p2b-ti\">\u23f1 <strong id=\"cms19p2b-td\">40:00<\/strong><\/div>\n <div class=\"sb-it\">\u2705 <strong id=\"cms19p2b-sc\">0<\/strong><\/div>\n <div class=\"sb-it\">\u274c <strong id=\"cms19p2b-sw\">0<\/strong><\/div>\n <div class=\"sb-it\">\u23f3 <strong id=\"cms19p2b-sr\">40<\/strong> left<\/div>\n <div class=\"sb-sep\"><\/div>\n <div class=\"sb-it\">Net <strong id=\"cms19p2b-sn\">0<\/strong> \/ <strong id=\"cms19p2b-sm\">160<\/strong><\/div>\n <\/div>\n <div class=\"sb-bar\"><div class=\"sb-fill\" id=\"cms19p2b-fill\"><\/div><\/div>\n<\/div>\n<div class=\"grace\" id=\"cms19p2b-grace\">\n <div class=\"gb\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"gc\" id=\"cms19p2b-gc\">10<\/div>\n <button class=\"gnow\" id=\"cms19p2b-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"hdr\">\n <h1>Combined Medical Services Examination 2019<br>Paper II \u00b7 Part B<\/h1>\n <p>Obstetrics & Gynaecology<\/p>\n <div class=\"meta\">\n <span class=\"bdg\">Questions 41 \u2013 80<\/span>\n <span class=\"bdg\">Options reshuffled<\/span>\n <button class=\"tbtn\" id=\"cms19p2b-tbtn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"body\">\n <div id=\"cms19p2b-qs\"><\/div>\n <div class=\"sw\"><button class=\"btn\" id=\"cms19p2b-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms19p2b-sc-box\">\n <div class=\"ring\" id=\"cms19p2b-ring\"><div class=\"ri\"><span class=\"rp\" id=\"cms19p2b-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms19p2b-nl\"><\/div>\n <div class=\"vd\" id=\"cms19p2b-vd\"><\/div>\n <div class=\"bands\">\n <span class=\"band bc\" id=\"cms19p2b-bc\"><\/span>\n <span class=\"band bw\" id=\"cms19p2b-bw\"><\/span>\n <span class=\"band bs\" id=\"cms19p2b-bs\"><\/span>\n <\/div>\n <button class=\"rbtn\" id=\"cms19p2b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms19p2b',TOTAL=40,MAX=160,TSECS=2400,GSECS=10;\nvar QS=[\n{id:41,stem:'Which of the following is NOT the hormonal basis for hyperemesis gravidarum?',correct:'Excess of Human Placental Lactogen',options:['Excess of Chorionic Gonadotropin','Excess of Human Placental Lactogen','Excess of Progesterone','High serum levels of Estrogen'],exp:'Hyperemesis gravidarum \u2014 proposed hormonal mechanisms: EXCESS hCG \u2714 \u2014 strongest evidence; peak hCG at 8\u201312 weeks correlates with peak vomiting; higher hCG in molar pregnancy\/multiple gestation \u2192 severe HG. HIGH OESTROGEN \u2714 \u2014 exogenous oestrogen causes nausea; levels correlate with severity. EXCESS PROGESTERONE \u2714 \u2014 relaxes gastric smooth muscle \u2192 delayed gastric emptying \u2192 nausea. HUMAN PLACENTAL LACTOGEN (hPL) \u2717 \u2014 hPL is produced by the syncytiotrophoblast and regulates fetal nutrition\/IGF axis; it does NOT have a recognised role in the causation of nausea and vomiting of pregnancy. Answer: Excess of Human Placental Lactogen.'},\n{id:42,stem:'Consider the following statements regarding pregnancy with Rh isoimmunisation:\\n1. Indirect Coombs test is performed in mother\\n2. Methergin is withheld at delivery of anterior shoulder\\n3. Middle cerebral artery peak systolic velocity is an accurate method to predict fetal anaemia\\nWhich of the statements given above are correct?',correct:'1 and 3 only',options:['1 and 2 only','1, 2 and 3','2 and 3 only','1 and 3 only'],exp:'Statement 1 \u2714 \u2014 INDIRECT Coombs test (ICT) is performed on MATERNAL serum to detect antibodies (anti-D) in the mother\\'s circulation. Direct Coombs test is done on fetal\/neonatal red cells. Statement 2 \u2717 \u2014 METHERGIN (methylergometrine) is withheld at delivery of the ANTERIOR SHOULDER in Rh-negative mothers (NOT because of Rh isoimmunisation per se); actually Methergin is withheld to avoid tetanic uterine contraction that would force fetal blood into maternal circulation increasing fetomaternal haemorrhage. However, the classical teaching is that Syntometrine\/Syntocinon is used but Methergin is avoided to reduce FMH risk. This statement is partly contextually incorrect for the specific indication. Statement 3 \u2714 \u2014 MCA-PSV (Mari\\'s criteria): MCA-PSV >1.5 MoM predicts moderate-to-severe fetal anaemia with high sensitivity (~100%), replacing amniocentesis for \u0394OD450. Correct statements: 1 and 3. Answer: 1 and 3 only.'},\n{id:43,stem:'In fetus with Spina bifida, which of the following sign\/signs may be seen on ultrasound?',correct:'All of these',options:['Lemon sign','Banana sign','Defect seen in vertebral bodies or tissue overlying it','All of these'],exp:'Ultrasound signs in fetal spina bifida (open neural tube defect): LEMON SIGN \u2714 \u2014 frontal bossing \/ scalloping of frontal bones giving a lemon shape on axial head section; due to herniation of hindbrain (Arnold-Chiari II) causing negative pressure on skull. BANANA SIGN \u2714 \u2014 cerebellum wraps around the brainstem into a curved banana shape (small posterior fossa, obliteration of cisterna magna) due to downward traction of hindbrain. DIRECT DEFECT \u2714 \u2014 posterior vertebral arch defect \u00b1 meningocele\/myelomeningocele sac visible in spine on sagittal\/coronal views. All three signs may be detected on second-trimester anomaly scan. Answer: All of these.'},\n{id:44,stem:'In pregnancy with Down syndrome, consider the following biomarkers:\\n1. \u03b2-hCG is raised\\n2. \u03b1-FP is raised\\n3. Inhibin is decreased\\nWhich of the above statements is\/are correct?',correct:'1 only',options:['1, 2 and 3','1 only','2 and 3 only','1 and 2 only'],exp:'Down syndrome (Trisomy 21) serum screening markers (Triple\/Quadruple test): \u03b2-hCG: RAISED \u2714 (statement 1 correct). \u03b1-FP (AFP): DECREASED \u2717 (statement 2 incorrect \u2014 AFP is LOW in Down syndrome; HIGH AFP suggests NTD\/abdominal wall defects). Inhibin A: RAISED \u2717 (statement 3 incorrect \u2014 Inhibin A is ELEVATED, not decreased, in Down syndrome; it is the fourth marker in the quadruple test). Unconjugated oestriol (uE3): decreased. Mnemonic for Down: hCG \u2191, AFP \u2193, uE3 \u2193, Inhibin A \u2191. Only statement 1 is correct. Answer: 1 only.'},\n{id:45,stem:'A 25-year-old G2P1L1, Rh-negative woman at 30 weeks gestation has a positive Indirect Coombs Test (ICT). What would be the next line of management?',correct:'ICT titers to be closely monitored at weekly intervals',options:['Anti-D to be given','ICT titers to be closely monitored at weekly intervals','Amniocentesis for estimation of bilirubin by Liley\\'s chart is to be done','Baby is to be delivered as soon as possible'],exp:'Positive ICT in an Rh-negative mother means she is ALREADY sensitised \u2014 Anti-D immunoglobulin is now USELESS (cannot prevent what has already happened). Management of established Rh sensitisation at 30 weeks: MONITOR ICT TITRES \u2714 \u2014 serial titres every 2\u20134 weeks. If titre <1:8 (or <1:16 by some criteria) \u2192 continue monitoring. If titre \u22651:16 \u2192 MCA-PSV Doppler (now preferred over amniocentesis). Amniocentesis for Liley\\'s chart is outdated; MCA-PSV has replaced it. Delivery at 30 weeks is premature without evidence of fetal compromise. Anti-D is pointless once sensitised. Answer: ICT titers to be closely monitored at weekly intervals.'},\n{id:46,stem:'Given below are obstetric manoeuvres and their indications. Which one of the following is correctly matched?',correct:'Ritgen\\'s manoeuvre \u2013 Controlled delivery of fetal head',options:['McRobert\\'s manoeuvre \u2013 After coming head of breech','Lovset\\'s manoeuvre \u2013 Delivery of foot in breech','Pinard\\'s manoeuvre \u2013 Delivery of extended arm','Ritgen\\'s manoeuvre \u2013 Controlled delivery of fetal head'],exp:'Obstetric manoeuvre matching: McRobert\\'s \u2717 \u2014 used for SHOULDER DYSTOCIA (hyperflexion of maternal thighs onto abdomen to open pelvic inlet), NOT for after-coming head of breech (that is Mauriceau-Smellie-Veit). Lovset\\'s \u2717 \u2014 for delivery of EXTENDED ARMS in breech (rotating the trunk to bring arm anteriorly), NOT for delivery of foot (Pinard\\'s is for foot). Pinard\\'s \u2717 \u2014 for delivery of extended LEGS\/FEET in frank breech (fingers placed on popliteal fossa to flex knee and bring leg down), NOT extended arm. Ritgen\\'s manoeuvre \u2714 \u2014 used for controlled delivery of the fetal HEAD in vertex delivery; fingers of one hand behind the perineum press upward on the fetal chin while the other hand controls cranial descent \u2014 prevents perineal tears. Answer: Ritgen\\'s manoeuvre \u2013 Controlled delivery of fetal head.'},\n{id:47,stem:'The maternal serum \u03b1-fetoprotein level is elevated in all EXCEPT:',correct:'Down syndrome',options:['Down syndrome','Neural tube defect','Intrauterine death','Omphalocele'],exp:'Causes of ELEVATED maternal serum AFP: NEURAL TUBE DEFECTS \u2714 \u2014 anencephaly, open spina bifida, encephalocele; AFP leaks from exposed neural tissue. INTRAUTERINE DEATH \u2714 \u2014 fetal tissue breakdown releases AFP. OMPHALOCELE \u2714 \u2014 abdominal wall defect; AFP leaks into amniotic fluid. Also: gastroschisis, multiple pregnancy, incorrect gestational age, Turner syndrome. DOWN SYNDROME (Trisomy 21) \u2717 \u2014 AFP is characteristically LOW\/DECREASED in Down syndrome (the triple screen: \u2193AFP, \u2191hCG, \u2193uE3). Down syndrome is the classic exception. Answer: Down syndrome.'},\n{id:48,stem:'Which one of the following statements regarding Bartholin\\'s glands is NOT true?',correct:'Gonococci is the most common causing Bartholin\\'s abscess',options:['They are situated in superficial perineal pouch','Duct opens at the junction between anterior one third and posterior two third between hymen and labium minus','Gonococci is the most common causing Bartholin\\'s abscess','The duct is lined by columnar epithelium'],exp:'Bartholin\\'s gland facts: Situated in superficial perineal pouch \u2714 \u2014 in the posterior part of the labium majus. Duct opening \u2714 \u2014 at the junction of the anterior 1\/3 and posterior 2\/3 of the groove between hymen and labium minus (at 4 and 8 o\\'clock). Gonococci as most common cause \u2717 \u2014 INCORRECT. In the past gonococci were the classic cause, but CURRENTLY the most common organisms in Bartholin\\'s abscess are MIXED ANAEROBES and skin commensals (E. coli, Bacteroides, Staphylococci); N. gonorrhoeae now accounts for only a small minority. Duct lined by columnar epithelium \u2714 \u2014 transitional near opening, columnar (mucous) in the gland. Answer: Gonococci is the most common causing Bartholin\\'s abscess.'},\n{id:49,stem:'An 18-year-old unmarried girl presents with heavy, prolonged bleeding during menses. Which among the following investigations is NOT usually advised?',correct:'Dilatation and curettage',options:['Urine pregnancy test','Ultrasound uterus and adnexa','Coagulation profile','Dilatation and curettage'],exp:'Work-up for heavy menstrual bleeding (HMB) in an 18-year-old: URINE PREGNANCY TEST \u2714 \u2014 must exclude pregnancy\/ectopic as a cause of abnormal uterine bleeding. ULTRASOUND \u2714 \u2014 to assess uterine and adnexal pathology (fibroid, polyp, ovarian cyst). COAGULATION PROFILE \u2714 \u2014 adolescent-onset HMB has a high prevalence of coagulation disorders (von Willebrand disease ~13%, ITP, platelet dysfunction). DILATATION AND CURETTAGE \u2717 \u2014 NOT indicated in a young adolescent as a first-line investigation; D&C is an invasive operative procedure not appropriate in virginal\/adolescent patients for diagnosis; endometrial malignancy is extremely rare at 18. Hysteroscopy \u00b1 directed biopsy would be preferred if needed. Answer: Dilatation and curettage.'},\n{id:50,stem:'Which one of the following is true about Basal Body Temperature?\\n1. Biphasic pattern\\n2. Increase in the level of progesterone and norepinephrine\\n3. Temperature falls by 0.5\u02daC after ovulation\\n4. It can predict ovulation precisely\\nSelect the correct answer:',correct:'1 and 2',options:['1 and 3','1 and 2','1 and 4','2 and 3'],exp:'Basal Body Temperature (BBT) chart: Statement 1 \u2714 \u2014 BBT shows a BIPHASIC pattern: lower in follicular phase, rises ~0.2\u20130.5\u00b0C after ovulation (progesterone-mediated), stays elevated in luteal phase. Statement 2 \u2714 \u2014 The post-ovulatory rise is due to increased PROGESTERONE (thermogenic effect); norepinephrine is also cited in thermogenic pathways (though progesterone is the primary mediator). Statement 3 \u2717 \u2014 Temperature RISES (not falls) by 0.2\u20130.5\u00b0C AFTER ovulation. Statement 4 \u2717 \u2014 BBT can confirm that ovulation HAS occurred but CANNOT PREDICT ovulation in advance; the rise is detected AFTER the LH surge\/ovulation. It is retrospective, not predictive. Correct: 1 and 2. Answer: 1 and 2.'},\n{id:51,stem:'Consider the following statements regarding infertility:\\n1. Endometrial biopsy provides information regarding ovulatory factor\\n2. Both tubal and peritoneal factors can be assessed at laparoscopy\\n3. Unexplained infertility may be due to luteal phase defect\\nWhich of the statements given above is\/are correct?',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1 and 3 only','1, 2 and 3'],exp:'Statement 1 \u2714 \u2014 Endometrial biopsy (secretory phase, day 21\u201326) shows secretory transformation \u2192 confirms ovulation and assesses luteal phase adequacy (luteal phase defect). Statement 2 \u2714 \u2014 Diagnostic LAPAROSCOPY is the gold standard for assessing: tubal patency (via chromopertubation with methylene blue), peritubal\/periovarian adhesions, endometriosis, and other peritoneal factors \u2014 all in one procedure. Statement 3 \u2714 \u2014 Unexplained infertility (normal semen analysis, normal ovulation, normal tubes) may be due to subtle defects including luteal phase deficiency (inadequate progesterone support), subtle endometriosis, sperm-oocyte interaction defects, or immunological factors. All three statements are correct. Answer: 1, 2 and 3.'},\n{id:52,stem:'Which one of the following about primary dysmenorrhoea is NOT true?',correct:'Pain increases following pregnancy and delivery',options:['Confined to adolescent','Always confined to ovulatory cycles','Pain increases following pregnancy and delivery','Pain is related to uterine hypoxia'],exp:'Primary dysmenorrhoea: Confined to adolescents \u2714 (in the sense that it begins at menarche\/adolescence and tends to improve with age; onset always in teens\/young adults). Always in OVULATORY cycles \u2714 \u2014 primary dysmenorrhoea requires ovulation; it only occurs when progesterone primes the endometrium to produce prostaglandins at menstruation; anovulatory cycles are pain-free. Pain related to uterine hypoxia \u2714 \u2014 prostaglandins (PGF2\u03b1, PGE2) cause uterine hypercontractility and vasoconstriction \u2192 ischaemia \u2192 pain (similar to angina mechanism). Pain increases following pregnancy \u2717 \u2014 FALSE. A classic teaching point is that primary dysmenorrhoea typically IMPROVES or RESOLVES after pregnancy and vaginal delivery (cervical dilatation, uterine restructuring). Answer: Pain increases following pregnancy and delivery.'},\n{id:53,stem:'Consider the following statements regarding diameters of a normal female pelvis:\\n1. AP diameter is the shortest diameter at brim\\n2. Oblique diameter is the largest diameter of inlet\\n3. Diagonal conjugate cannot be directly measured\\nWhich of the statements given above is\/are correct?',correct:'1 only',options:['1 and 2 only','1, 2 and 3','1 only','2 only'],exp:'Pelvic inlet diameters: AP (antero-posterior \/ true conjugate = conjugate vera = 11 cm): is the SHORTEST diameter at the pelvic brim \u2714 (statement 1 correct). TRANSVERSE diameter (13.5 cm) is the WIDEST\/LARGEST diameter of the pelvic inlet \u2014 NOT the oblique. Oblique diameter (12.5 cm) is intermediate. Statement 2 \u2717 \u2014 The TRANSVERSE diameter is the largest, not the oblique. Statement 3 \u2717 \u2014 The DIAGONAL conjugate (from pubic symphysis lower border to sacral promontory) IS directly measurable by vaginal examination (approximately 12.5 cm); the TRUE conjugate (obstetric conjugate) cannot be measured directly and is estimated from the diagonal conjugate minus 1.5 cm. Only statement 1 is correct. Answer: 1 only.'},\n{id:54,stem:'Which of the following is NOT a characteristic clinical feature of Bacterial Vaginosis?',correct:'Thick curdy discharge',options:['Vaginal pH \u2265 5','Thick curdy discharge','Amine odour in 10% KOH test','Clue cells'],exp:'Bacterial Vaginosis (BV) \u2014 Amsel\\'s criteria (3 of 4 for diagnosis): Vaginal pH \u22654.5 (>5) \u2714 \u2014 alkaline (loss of Lactobacillus acid production). AMINE (fishy) odour on 10% KOH (Whiff test) \u2714 \u2014 volatile amines released from anaerobes. CLUE CELLS \u2714 \u2014 epithelial cells covered with bacteria (Gardnerella), stippled appearance on wet mount. Thin, white\/grey, homogeneous discharge \u2714 \u2014 NOT thick and curdy. THICK CURDY (cottage cheese) WHITE DISCHARGE \u2717 \u2014 this is the hallmark of CANDIDA (vulvovaginal candidiasis), not BV. BV discharge is thin, grey, and fishy-smelling. Answer: Thick curdy discharge.'},\n{id:55,stem:'Which of the following are the vaccines for prevention of cervical cancer?\\n1. Cervarix\\n2. Gardasil\\n3. T-dap\\n4. Influenza\\nSelect the correct answer:',correct:'1 and 2',options:['1 and 3','2 and 3','1 and 2','2 and 4'],exp:'HPV vaccines for cervical cancer prevention: CERVARIX \u2714 (bivalent: HPV 16 and 18) \u2014 targets the two strains responsible for ~70% of cervical cancers. GARDASIL \u2714 (quadrivalent: HPV 6, 11, 16, 18; or 9-valent: adds 31, 33, 45, 52, 58) \u2014 covers high-risk and low-risk strains. T-dap \u2717 \u2014 Tetanus, diphtheria, acellular pertussis vaccine; completely unrelated to cervical cancer. Influenza \u2717 \u2014 flu vaccine; unrelated to HPV\/cervical cancer. Answer: 1 and 2 (Cervarix and Gardasil).'},\n{id:56,stem:'Consider the following statements regarding Carcinoma Cervix:\\n1. Clinical staging is done\\n2. Treatment if provided in stage I leads to survival rate of 80\u201390%\\n3. Surgery is preferred in young women with stage III disease\\n4. HPV virus is considered to be the causative agent\\nWhich of the statements given above are correct?',correct:'1, 2 and 4 only',options:['1 and 2 only','1, 2 and 4 only','3 and 4 only','1, 2, 3 and 4'],exp:'Statement 1 \u2714 \u2014 Carcinoma cervix uses CLINICAL staging (FIGO); imaging findings can be incorporated per revised 2018 FIGO but clinical examination remains the basis; surgical staging is NOT standard. Statement 2 \u2714 \u2014 Stage I (confined to cervix): 5-year survival 80\u201390% with appropriate treatment (surgery or radiotherapy). Statement 3 \u2717 \u2014 Stage III (extension to pelvic wall\/lower third vagina or hydronephrosis): treatment is CHEMORADIATION (concurrent cisplatin + external beam RT + brachytherapy); surgery is NOT preferred for Stage III as the disease is locally advanced. Surgery preferred in Stage IA\u2013IIA (young women). Statement 4 \u2714 \u2014 HPV (particularly types 16 and 18) is the established causative\/necessary agent in virtually all cervical cancers. Correct: 1, 2 and 4. Answer: 1, 2 and 4 only.'},\n{id:57,stem:'Which one of the following is NOT a mandatory procedure for FIGO staging of Carcinoma cervix?',correct:'Ultrasound abdomen',options:['Pelvic examination','Biopsy','Ultrasound abdomen','Endocervical curettage'],exp:'FIGO staging of carcinoma cervix \u2014 permitted\/mandatory procedures (traditional clinical staging): PELVIC EXAMINATION \u2714 \u2014 mandatory; under anaesthesia for assessment of parametria, pelvic wall, vaginal extension. BIOPSY \u2714 \u2014 histological confirmation is mandatory before staging\/treatment. ENDOCERVICAL CURETTAGE \u2714 \u2014 mandatory to assess endocervical extension (distinguishes stage I from stage II). Other permitted: colposcopy, chest X-ray, IVP, barium enema, cystoscopy, proctoscopy, skeletal X-rays. ULTRASOUND ABDOMEN \u2717 \u2014 NOT a mandatory procedure in traditional FIGO clinical staging; advanced cross-sectional imaging (CT, MRI, PET) findings were not incorporated in earlier FIGO systems (though 2018 revision allows imaging). Answer: Ultrasound abdomen.'},\n{id:58,stem:'Consider the following statements regarding Uterine Leiomyoma:\\n1. Prevalence is highest between 35 and 45 years\\n2. More common in nulliparous women\\n3. Display reversible shrinkage after treatment with GnRH\\n4. Requires to be treated only if symptomatic\\nWhich of the statements given above are correct?',correct:'1, 2, 3 and 4',options:['2 and 3 only','1 and 4 only','1, 2 and 3 only','1, 2, 3 and 4'],exp:'Uterine leiomyoma (fibroid) facts: Statement 1 \u2714 \u2014 prevalence peaks between 35\u201345 years (oestrogen-dependent growth; postmenopausal regression). Statement 2 \u2714 \u2014 more common in nulliparous\/low-parity women; pregnancy has a protective effect (progesterone remodels uterus; fewer cycles of oestrogen stimulation). Statement 3 \u2714 \u2014 GnRH agonists (leuprolide, goserelin) create a hypoestrogenic state \u2192 30\u201360% reduction in fibroid volume; effect is REVERSIBLE (fibroids regrow after stopping therapy); used for 3\u20136 months pre-operatively. Statement 4 \u2714 \u2014 Asymptomatic fibroids do NOT require treatment; intervention only when symptomatic (AUB, pressure symptoms, infertility, recurrent miscarriage) or rapidly growing. All four correct. Answer: 1, 2, 3 and 4.'},\n{id:59,stem:'A 58-year-old woman with suspected ovarian cancer was operated for surgical staging. Both ovaries involved, capsule ruptured, ascites with malignant cells. Uterus and tubes normal, no peritoneal implants. The FIGO stage for this patient would be:',correct:'Stage I',options:['Stage I','Stage II','Stage III','Stage IV'],exp:'FIGO staging of ovarian cancer: Stage I: tumour confined to one or both ovaries. Stage IA: one ovary, intact capsule. Stage IB: both ovaries, intact capsule. Stage IC: one or both ovaries PLUS any of \u2014 surgical spill (IC1), ruptured capsule before surgery (IC2), tumour on ovarian surface or malignant cells in ascites\/peritoneal washings (IC3). Stage II: pelvic extension. Stage III: peritoneal implants beyond pelvis or retroperitoneal nodes. Stage IV: distant metastases. This patient: BOTH ovaries involved + capsule ruptured + malignant cells in ascites. Uterus\/tubes normal, NO peritoneal implants beyond the ovaries. = Stage IC (both ovaries + capsule rupture + malignant ascites). Still STAGE I overall. Answer: Stage I.'},\n{id:60,stem:'Which one of the following is the serum marker in epithelial ovarian cancer?',correct:'CA\u2013125',options:['CA\u2013125','CEA','AFP','HCG'],exp:'Tumour markers in ovarian cancer by histological type: EPITHELIAL ovarian cancer (serous, mucinous, endometrioid, clear cell \u2014 90% of ovarian cancers): CA-125 \u2714 \u2014 elevated in >80% of advanced serous epithelial ovarian cancers; used for diagnosis, monitoring response, and detecting recurrence. CEA: colorectal and mucinous ovarian tumours. AFP: yolk sac tumour (germ cell). hCG: choriocarcinoma, gestational trophoblastic disease. LDH: dysgerminoma. Inhibin: granulosa cell tumour. CA-125 is the PRIMARY marker for epithelial ovarian cancer. Answer: CA-125.'},\n{id:61,stem:'Which one of the following is NOT an ideally suited condition for use of ring pessary in case of uterine prolapse?',correct:'Late pregnancy',options:['Late pregnancy','Puerperium','Patient unfit for surgery','Patient\\'s unwillingness for surgery'],exp:'Ring pessary (Hodge pessary\/ring) for uterine prolapse \u2014 indications: PUERPERIUM \u2714 \u2014 prolapse in early puerperium may resolve with pelvic floor exercises; pessary provides temporary support. UNFIT FOR SURGERY \u2714 \u2014 elderly patients with comorbidities who cannot tolerate general\/spinal anaesthesia. UNWILLINGNESS FOR SURGERY \u2714 \u2014 patient\\'s choice. As temporising measure before surgery \u2714. LATE PREGNANCY \u2717 \u2014 a gravid uterus is bulky and retroverted in early pregnancy but in LATE pregnancy a ring pessary would be physically impossible to position correctly (enlarged uterus fills the pelvis) and would compress pelvic structures; it is NOT an indication. Answer: Late pregnancy.'},\n{id:62,stem:'Labour is called normal if it fulfils following criteria EXCEPT:',correct:'Vaginal breech delivery',options:['Vaginal breech delivery','Vaginal delivery with episiotomy','Vertex presentation','Spontaneous onset at term'],exp:'Criteria for NORMAL labour (WHO\/standard obstetrics): Spontaneous onset at TERM (37\u201342 weeks) \u2714. VERTEX presentation (cephalic \u2014 occiput presenting) \u2714. SPONTANEOUS progress of labour \u2714. Delivery of baby (vaginal) and placenta without undue complications \u2714. Vaginal delivery WITH episiotomy \u2714 \u2014 episiotomy does not disqualify labour from being normal (episiotomy is a minor surgical adjunct). VAGINAL BREECH DELIVERY \u2717 \u2014 breech presentation is an ABNORMAL lie\/presentation; breech labour\/delivery is classified as abnormal\/malpresentation regardless of the vaginal route. Normal labour requires vertex presentation by definition. Answer: Vaginal breech delivery.'},\n{id:63,stem:'Which one of the following methods is NOT used for cervical cancer screening?',correct:'Cervical biopsy',options:['Pap smear','VIA','VILI','Cervical biopsy'],exp:'Cervical cancer SCREENING methods (for asymptomatic women): PAP SMEAR (Papanicolaou) \u2714 \u2014 cytological screening; detects dysplasia. VIA (Visual Inspection with Acetic acid) \u2714 \u2014 acetowhite changes identify CIN; low-resource settings. VILI (Visual Inspection with Lugol\\'s Iodine) \u2714 \u2014 abnormal areas fail to stain (iodine-negative); complementary to VIA. Also: HPV DNA testing, liquid-based cytology. CERVICAL BIOPSY \u2717 \u2014 biopsy is a DIAGNOSTIC procedure, NOT a screening test. Biopsy is performed on a suspicious lesion to confirm histological diagnosis; it cannot be applied to the general asymptomatic population. Screening \u2260 diagnosis. Answer: Cervical biopsy.'},\n{id:64,stem:'Consider the following regarding the use of Magnesium Sulphate:\\n1. Used as tocolytic\\n2. As neuroprotective agent\\n3. Used in management of postpartum eclampsia\\nWhich of the statements given above are correct?',correct:'1, 2 and 3',options:['1 and 2 only','1, 2 and 3','1 and 3 only','2 and 3 only'],exp:'Magnesium sulphate uses in obstetrics: Statement 1 \u2714 \u2014 MgSO\u2084 is used as a TOCOLYTIC (inhibits uterine contractions) to delay preterm labour for 48h (to allow steroid administration and in-utero transfer); though less effective than nifedipine\/atosiban, it is used particularly for neuroprotection simultaneously. Statement 2 \u2714 \u2014 NEUROPROTECTIVE: MgSO\u2084 given to mothers in preterm labour <32 weeks reduces the risk of cerebral palsy in the preterm neonate (ACOG\/RCOG recommendation). Statement 3 \u2714 \u2014 ECLAMPSIA treatment and PREVENTION of recurrent seizures \u2014 both antepartum AND POSTPARTUM eclampsia; Pritchard\/Zuspan regimen used; postpartum seizures can occur up to 48h after delivery and MgSO\u2084 is continued. All three correct. Answer: 1, 2 and 3.'},\n{id:65,stem:'Which one of the following is NOT a common cause of recurrent abortions?',correct:'TORCH group of infections',options:['Maternal diabetes','TORCH group of infections','Antiphospholipid syndrome','Chromosomal abnormality'],exp:'Causes of RECURRENT PREGNANCY LOSS (RPL \u22653 consecutive losses): CHROMOSOMAL ABNORMALITY \u2714 \u2014 parental chromosomal translocations (balanced) account for 3\u20135% RPL; also sporadic aneuploidy. ANTIPHOSPHOLIPID SYNDROME \u2714 \u2014 the most important treatable cause; anticardiolipin antibodies + lupus anticoagulant \u2192 thrombosis of placental vessels \u2192 repeated fetal loss. MATERNAL DIABETES (uncontrolled) \u2714 \u2014 hyperglycaemia \u2192 embryopathy, miscarriage. Also: uterine anomalies, thrombophilias, luteal phase defect, thyroid disorders. TORCH INFECTIONS \u2717 \u2014 TORCH group (Toxoplasma, Rubella, CMV, Herpes) are causes of TERATOGENESIS, stillbirth, and neonatal disease; they are NOT a recognised common cause of RECURRENT abortions (each infection causes sporadic loss, not a pattern of recurrence). Answer: TORCH group of infections.'},\n{id:66,stem:'Contraindications to Uterine Cerclage for Incompetent os are all EXCEPT:',correct:'Previous history suggestive of abortion due to incompetent os',options:['Previous history suggestive of abortion due to incompetent os','Ruptured membrane','Bulging membrane','History of vaginal bleeding'],exp:'Cervical cerclage \u2014 contraindications: RUPTURED MEMBRANES \u2714 \u2014 procedure risks infection\/cord prolapse. BULGING MEMBRANES \u2714 \u2014 technically difficult, risk of membrane rupture during insertion (relative contraindication; some centres attempt with special precautions). VAGINAL BLEEDING \u2714 \u2014 suggests threatened abortion; inserting cerclage in this setting may exacerbate loss. Active infection (chorioamnionitis) \u2714. Major fetal anomalies \u2714. PREVIOUS HISTORY of abortion due to incompetent os \u2717 \u2014 this is the PRIMARY INDICATION for cerclage, NOT a contraindication. A history of mid-trimester losses with painless cervical dilatation is exactly what elective cerclage is performed for. Answer: Previous history suggestive of abortion due to incompetent os.'},\n{id:67,stem:'The most common cause of early spontaneous abortion is:',correct:'Chromosomal abnormality',options:['Chromosomal abnormality','Infection','Endocrine disorder','Teratogens'],exp:'Early spontaneous abortion (first trimester, <12 weeks) \u2014 aetiology: CHROMOSOMAL ABNORMALITY \u2714 \u2014 accounts for ~50\u201360% of all first-trimester spontaneous abortions. Most common: Autosomal trisomy (~52%), especially trisomy 16; monosomy X (45,X) ~19%; triploidy ~16%. This chromosomal error is overwhelmingly the most frequent cause. Infection: rarely causes isolated early sporadic abortion. Endocrine (progesterone deficiency, thyroid): more relevant for RECURRENT losses. Teratogens: cause anomalies; may contribute to abortion but not the most common cause. Answer: Chromosomal abnormality.'},\n{id:68,stem:'Cause of Fetal growth restriction may be:\\n1. Chromosomal abnormality\\n2. Congenital abnormality\\n3. Abnormal cord insertion\\nWhich of the statements given above is\/are correct?',correct:'1, 2 and 3',options:['1 and 2 only','2 and 3 only','1, 2 and 3','1 and 3 only'],exp:'Causes of Fetal Growth Restriction (FGR): FETAL factors: Chromosomal abnormalities \u2714 (trisomies 13, 18, 21; Turner syndrome) \u2014 intrinsically small fetuses. Congenital abnormalities \u2714 (structural defects, congenital infections \u2014 TORCH). PLACENTAL factors: Abnormal cord insertion \u2714 \u2014 velamentous or marginal cord insertion \u2192 impaired nutrient transfer \u2192 FGR. Also: placental abruption, placenta praevia, circumvallate placenta, infarcts. MATERNAL factors: hypertension, malnutrition, smoking, drugs, alcohol. All three stated causes (chromosomal, congenital, cord insertion) are valid. Answer: 1, 2 and 3.'},\n{id:69,stem:'Which one of the following regarding fetal growth restriction is NOT true?',correct:'Delivery always at 34 weeks',options:['Daily fetal movement count is advised','Biophysical profile is done','Delivery always at 34 weeks','Umbilical artery Doppler studies are done'],exp:'Fetal Growth Restriction management: DAILY FETAL MOVEMENT COUNT \u2714 \u2014 kick charts are advised; decreased movements trigger further assessment. BIOPHYSICAL PROFILE \u2714 \u2014 BPP (NST + 4 ultrasound parameters) quantifies fetal wellbeing. UMBILICAL ARTERY DOPPLER \u2714 \u2014 gold standard surveillance in FGR; absent\/reversed end-diastolic flow indicates severe compromise and guides delivery timing. DELIVERY ALWAYS AT 34 WEEKS \u2717 \u2014 FALSE. Delivery timing in FGR is INDIVIDUALISED based on: severity of Doppler abnormality, BPP score, CTG findings, gestational age. Absent EDF \u2192 deliver ~34 weeks; reversed EDF \u2192 deliver earlier (~30\u201332 weeks; sometimes sooner). Mild FGR with normal Doppler may be monitored to 37+ weeks. \"Always at 34 weeks\" is incorrect. Answer: Delivery always at 34 weeks.'},\n{id:70,stem:'Which one of the following statements regarding contraception is NOT true?',correct:'Vaginal ring is a barrier method',options:['Vaginal ring is a barrier method','Implanon is a hormonal contraceptive','Copper T can be used as post coital contraception','Copper T can be inserted just after delivery'],exp:'Vaginal ring (NuvaRing) \u2717 \u2014 NOT a barrier method. It is a COMBINED HORMONAL contraceptive device: releases etonogestrel + ethinylestradiol locally; works by inhibiting ovulation, thickening cervical mucus. Barrier methods = condoms, diaphragm, cervical cap. Implanon \u2714 \u2014 a single-rod subdermal implant releasing etonogestrel; hormonal contraceptive. Copper T as post-coital contraception \u2714 \u2014 Copper IUD inserted within 5 days of unprotected intercourse is the most effective emergency contraception (>99% effective). Copper T just after delivery \u2714 \u2014 POST-PLACENTAL insertion (within 10 minutes of placenta delivery) is safe, highly effective, and recommended. Answer: Vaginal ring is a barrier method.'},\n{id:71,stem:'A 26-year-old P2L2 has just had delivery. What are the contraceptive choices she has at present?\\n1. Post placental insertion of IUCD\\n2. Post partum ligation\\n3. Oral contraceptive pill\\n4. Lap ligation\\nSelect the correct answer:',correct:'1 and 2 only',options:['1 and 2 only','1, 2 and 4','2 only','1 and 3'],exp:'Immediate post-delivery contraception options: POST-PLACENTAL IUCD \u2714 (option 1) \u2014 inserted within 10 minutes of placental delivery; safe, effective, highly recommended in India under FP-LMIS programme. POST-PARTUM LIGATION \u2714 (option 2) \u2014 mini-laparotomy (Pomeroy\\'s technique) within 48h of delivery while the uterus is still elevated; recommended for women who have completed family. ORAL CONTRACEPTIVE PILL \u2717 (option 3) \u2014 COMBINED OCP is contraindicated in the immediate postpartum period if breastfeeding (oestrogen suppresses lactation; WHO Category 4 <6 weeks postpartum while breastfeeding). LAPAROSCOPIC LIGATION \u2717 (option 4) \u2014 laparoscopy is technically difficult immediately postpartum (enlarged uterus, distorted anatomy); not performed at this time (done after 6 weeks). Correct: 1 and 2. Answer: 1 and 2 only.'},\n{id:72,stem:'A 22-year-old woman presents with pain and discomfort in vaginal region. On examination there is unilateral tender swelling in the posterior half of labium minus, overlying skin is red and oedematous. What is the most probable diagnosis?',correct:'Bartholin\\'s abscess',options:['Utero vaginal prolapse','Inversion of uterus','Bartholin\\'s abscess','Trichomoniasis'],exp:'BARTHOLIN\\'S ABSCESS: Bartholin\\'s gland duct blockage \u2192 cyst \u2192 secondary infection \u2192 abscess. Classic features \u2714: UNILATERAL (glands are paired, one side affected), tender swelling in the POSTERIOR HALF of the labium majus\/minus (Bartholin\\'s gland lies in posterior labia), overlying skin RED and OEDEMATOUS (acute inflammation), pain and dyspareunia. Uterovaginal prolapse: descent of uterus\/vaginal walls; no acute swelling. Uterine inversion: obstetric emergency; uterus inverts through cervix. Trichomoniasis: diffuse vaginal discharge, no localised labial swelling. Unilateral posterior labial swelling + tenderness = Bartholin\\'s abscess. Answer: Bartholin\\'s abscess.'},\n{id:73,stem:'A 29-year-old woman has three consecutive first trimester spontaneous abortions. Examination reveals fibroid uterus. Which of the following types of uterine fibroids would most likely lead to recurrent abortions?',correct:'Submucosal',options:['Submucosal','Intramural','Subserosal','Cervical'],exp:'Fibroids and recurrent miscarriage \u2014 relationship by location: SUBMUCOSAL \u2714 \u2014 projects into the ENDOMETRIAL CAVITY; directly distorts the uterine cavity; impairs endometrial blood flow and implantation; causes decidual changes making the local environment hostile for the embryo. Most closely associated with recurrent miscarriage and infertility. INTRAMURAL \u2014 large intramural fibroids may distort the cavity and cause abortion but less directly. SUBSEROSAL \u2014 projects outward; no impact on endometrial cavity; does NOT cause recurrent abortion. CERVICAL \u2014 rare; may obstruct cervix but not the primary cause of recurrent first-trimester loss. Submucosal fibroid is the type most causally linked to recurrent abortion. Answer: Submucosal.'},\n{id:74,stem:'A 25-year-old infertile woman is noted to have blocked fallopian tube on Hysterosalpingography. Which of the following is the best next step for this woman?',correct:'Laparoscopy',options:['Clomiphene citrate therapy','Gonadotropin therapy','Laparoscopy','Intrauterine insemination'],exp:'Blocked fallopian tube on HSG: HSG is a screening\/first-line investigation. A single HSG showing tubal block can be due to: cornual spasm (false positive, ~15\u201320%), true proximal occlusion, distal hydrosalpinx, or peritubal adhesions. LAPAROSCOPY \u2714 \u2014 is the GOLD STANDARD next step to: (1) confirm or refute HSG findings, (2) assess extent of tubal disease, peritubal adhesions, endometriosis, (3) attempt surgical correction (salpingolysis, salpingostomy). Chromopertubation at laparoscopy confirms patency. Clomiphene\/gonadotropins: for ovulation induction \u2014 irrelevant if tubes are blocked. IUI: requires at least ONE patent tube \u2014 contraindicated if both blocked. Answer: Laparoscopy.'},\n{id:75,stem:'The contraceptive choice for a 38-year-old woman with chronic hypertension and history of dysmenorrhoea and menorrhagia (malignancy ruled out) is:',correct:'Levonorgestrel intrauterine device',options:['Copper intrauterine device','Levonorgestrel intrauterine device','Combined oral contraceptive pills','Sterilization'],exp:'This patient has: HYPERTENSION (chronic) + DYSMENORRHOEA + MENORRHAGIA. LEVONORGESTREL-IUD (Mirena) \u2714: locally delivers progestogen \u2192 endometrial atrophy \u2192 significantly reduces menstrual bleeding (treats menorrhagia) and dysmenorrhoea; highly effective contraception (>99%); no systemic oestrogen \u2192 SAFE in hypertension (WHO Category 1); lasts 5 years. COPPER IUD \u2717 \u2014 worsens dysmenorrhoea and menorrhagia; inappropriate here. COMBINED OCP \u2717 \u2014 contraindicated in women \u226535 years with hypertension (WHO Category 3\u20134); oestrogen raises BP and thrombotic risk. STERILISATION \u2717 \u2014 permanent; premature at 38 unless family is complete; does not address the menstrual symptoms. LNG-IUS perfectly addresses all three issues. Answer: Levonorgestrel intrauterine device.'},\n{id:76,stem:'Which one of the following drugs does NOT interfere with efficacy of oral contraceptive pills and increase the failure rates?',correct:'Ranitidine',options:['Ranitidine','Rifampicin','Ampicillin','Barbiturates'],exp:'Drugs reducing OCP efficacy (enzyme INDUCERS of CYP450 \u2192 accelerate oestrogen\/progestogen metabolism): RIFAMPICIN \u2714 \u2014 potent CYP3A4 inducer; most significant interaction; dramatically reduces contraceptive levels; additional contraception always required. BARBITURATES \u2714 \u2014 phenobarbitone is a CYP inducer; reduces OCP levels. AMPICILLIN \u2714 \u2014 disrupts enterohepatic recirculation of oestrogen by killing gut bacteria \u2192 reduces oestrogen reabsorption (though evidence is debated, it is classically listed). RANITIDINE \u2717 \u2014 H\u2082 blocker (anti-ulcer); does NOT induce CYP450 enzymes; does NOT affect OCP metabolism or efficacy. Answer: Ranitidine.'},\n{id:77,stem:'Which one of the following antihypertensive drugs is NOT safe during pregnancy?',correct:'ACE-inhibitors',options:['Labetalol','ACE-inhibitors','Alpha-methyl dopa','Nifedipine'],exp:'Antihypertensives in pregnancy \u2014 safety: ALPHA-METHYLDOPA \u2714 \u2014 drug of choice in pregnancy; longest safety record; central alpha-2 agonist; safe for fetus. LABETALOL \u2714 \u2014 alpha + beta blocker; safe and widely used in hypertensive emergencies of pregnancy (IV labetalol). NIFEDIPINE \u2714 \u2014 calcium channel blocker; used for acute severe hypertension and as tocolytic; safe. ACE INHIBITORS \u2717 \u2014 CONTRAINDICATED in pregnancy (ALL trimesters, especially 2nd and 3rd trimester). ACE inhibitors cause: fetal renal tubular dysgenesis, oligohydramnios, pulmonary hypoplasia, neonatal renal failure, skull ossification defects, IUGR, and fetal death. WHO Category X equivalent. Answer: ACE-inhibitors.'},\n{id:78,stem:'Tubectomy is commonly performed at which site of fallopian tube?',correct:'Isthmus',options:['Ampulla','Infundibulum','Isthmus','Cornua'],exp:'Tubectomy (female sterilisation) \u2014 site of tubal occlusion: ISTHMUS \u2714 \u2014 the most common site for tubectomy using the POMEROY technique (loop of isthmus ligated and excised) and modified Pomeroy. Reasons: isthmus is the narrowest, most accessible part; has the thickest muscular wall; easy to identify; adequate length of tube to ligate and excise; cornual end remains patent but ovum cannot traverse. AMPULLA \u2014 used in salpingectomy for ectopic but not standard tubectomy site. INFUNDIBULUM\/FIMBRIA \u2014 fimbriectomy is an older technique, now rarely used. CORNUA \u2014 cornual resection is a hysteroscopic technique for permanent sterilisation but not standard open tubectomy. Answer: Isthmus.'},\n{id:79,stem:'A 60-year-old woman presents with postmenopausal bleeding. On endometrial curettage she is diagnosed as endometrial carcinoma. Which one of the following is a risk factor for endometrial cancer?',correct:'Diabetes mellitus',options:['Multiparity','Oral contraceptive use','Smoking','Diabetes mellitus'],exp:'Endometrial carcinoma risk factors (oestrogen excess\/metabolic): DIABETES MELLITUS \u2714 \u2014 insulin resistance \u2192 hyperinsulinaemia \u2192 increased ovarian androgen \u2192 peripheral conversion to oestrone \u2192 endometrial stimulation; 2\u20133\u00d7 risk increase. Other risk factors: obesity, nulliparity\/low parity, early menarche\/late menopause, unopposed oestrogen therapy, tamoxifen use, Lynch syndrome. MULTIPARITY \u2717 \u2014 PROTECTIVE; progesterone during pregnancy opposes endometrial stimulation. OCP USE \u2717 \u2014 PROTECTIVE; combined OCP (progestogen component) reduces risk by 50%. SMOKING \u2717 \u2014 paradoxically PROTECTIVE (anti-oestrogenic effect of smoking); but this does not mean smoking is recommended. Answer: Diabetes mellitus.'},\n{id:80,stem:'A 29-year-old woman presents with amenorrhoea of 6 weeks and pain. Urine pregnancy test positive. Diffuse lower abdominal tenderness, guarding. Beta-hCG = 4000 mIU\/ml. Transvaginal ultrasound shows no pregnancy in uterus, no adnexal mass, but moderate fluid in abdomen. What is the next best step?',correct:'Emergency laparotomy',options:['Repeat Beta-hCG level in 48 hours','Institution of methotrexate','Emergency laparotomy','Wait and watch'],exp:'This presentation is a RUPTURED ECTOPIC PREGNANCY with haemoperitoneum until proven otherwise: Positive UPT + 6 weeks amenorrhoea \u2714. No intrauterine pregnancy on TVS \u2714. MODERATE FREE FLUID IN ABDOMEN \u2714 \u2014 haemoperitoneum (ruptured ectopic). PERITONEAL SIGNS \u2014 diffuse tenderness + guarding \u2714 \u2014 indicating significant intraperitoneal haemorrhage with peritoneal irritation. This patient is HAEMODYNAMICALLY compromised or imminently so. EMERGENCY LAPAROTOMY \u2714 \u2014 the ONLY correct step; immediate surgical intervention to control haemorrhage (salpingectomy). Methotrexate \u2717 \u2014 contraindicated when there is rupture\/haemoperitoneum\/haemodynamic instability. Repeat beta-hCG or wait-and-watch \u2717 \u2014 dangerous delays when patient has signs of haemoperitoneum. Answer: Emergency laparotomy.'}\n];\n\nfunction shuffle(a){var b=[].concat(a);for(var i=b.length-1;i>0;i--){var j=Math.floor(Math.random()*(i+1));var t=b[i];b[i]=b[j];b[j]=t;}return b;}\nvar L=['A','B','C','D'];\nvar ua={},ans=0,so={},sub=false,tr=false,rem=TSECS,ti=null,gi=null;\n\nfunction fmt(s){var m=Math.floor(s\/60),x=s%60;return(''+m).padStart(2,'0')+':'+(''+x).padStart(2,'0');}\n\nfunction startTimer(){\n if(tr||sub)return;tr=true;\n var btn=document.getElementById(NS+'-tbtn');btn.textContent='\u23f1 '+fmt(rem);btn.classList.add('run');\n document.getElementById(NS+'-ti').classList.add('on');\n ti=setInterval(function(){\n rem--;var d=fmt(rem);document.getElementById(NS+'-td').textContent=d;btn.textContent='\u23f1 '+d;\n if(rem<=300)document.getElementById(NS+'-ti').classList.add('warn');\n if(rem<=0){clearInterval(ti);ti=null;grace();}\n },1000);\n}\nfunction stopTimer(){if(ti){clearInterval(ti);ti=null;}tr=false;}\nfunction grace(){\n if(sub)return;var g=GSECS;document.getElementById(NS+'-gc').textContent=g;document.getElementById(NS+'-grace').classList.add('show');\n gi=setInterval(function(){g--;document.getElementById(NS+'-gc').textContent=g;if(g<=0){clearInterval(gi);gi=null;hideGrace();showScore();}},1000);\n}\nfunction hideGrace(){document.getElementById(NS+'-grace').classList.remove('show');if(gi){clearInterval(gi);gi=null;}}\n\nfunction build(){\n var c=document.getElementById(NS+'-qs');c.innerHTML='';ua={};ans=0;so={};sub=false;tr=false;rem=TSECS;\n stopTimer();if(gi){clearInterval(gi);gi=null;}hideGrace();\n document.getElementById(NS+'-sc-box').style.display='none';\n document.getElementById(NS+'-ti').classList.remove('on','warn');\n var btn=document.getElementById(NS+'-tbtn');btn.textContent='\u23f1 Start Timed Mode';btn.classList.remove('run');\n document.getElementById(NS+'-td').textContent=fmt(TSECS);\n stats();\n QS.forEach(function(q){\n var opts=shuffle(q.options);so[q.id]=opts;\n var d=document.createElement('div');d.className='card';\n d.innerHTML='<div class=\"qh\"><div class=\"qn\" id=\"'+NS+'-qn'+q.id+'\">'+q.id+'<\/div><div class=\"qt\">'+q.stem.replace(\/\\n\/g,'<br>')+'<\/div><\/div>'+\n '<div class=\"opts\" id=\"'+NS+'-op'+q.id+'\">'+\n opts.map(function(o,i){return '<div class=\"opt\" id=\"'+NS+'-o'+q.id+'_'+i+'\" role=\"button\" tabindex=\"0\"><span class=\"ol\">'+L[i]+'<\/span><span class=\"ot\">'+o+'<\/span><\/div>';}).join('')+\n '<\/div><div class=\"exp\" id=\"'+NS+'-ex'+q.id+'\"><div class=\"exl\">Explanation<\/div>'+q.exp+'<\/div>';\n c.appendChild(d);\n opts.forEach(function(_,i){document.getElementById(NS+'-o'+q.id+'_'+i).addEventListener('click',function(){pick(q.id,i);});});\n });\n}\n\nfunction pick(qid,oi){\n if(ua[qid]!==undefined||sub)return;\n var q=QS.find(function(x){return x.id===qid;});\n var opts=so[qid];var ok=opts[oi]===q.correct;\n ua[qid]=ok?'c':'w';ans++;\n opts.forEach(function(o,i){\n var el=document.getElementById(NS+'-o'+qid+'_'+i);\n if(o===q.correct)el.classList.add('co','lk');\n else if(i===oi)el.classList.add('wr','lk');\n else el.classList.add('dm','lk');\n });\n document.getElementById(NS+'-qn'+qid).classList.add(ok?'c':'w');\n document.getElementById(NS+'-ex'+qid).style.display='block';\n stats();\n}\n\nfunction stats(){\n var c=Object.values(ua).filter(function(v){return v==='c';}).length;\n var w=Object.values(ua).filter(function(v){return v==='w';}).length;\n var net=c*4-w;\n document.getElementById(NS+'-sc').textContent=c;\n document.getElementById(NS+'-sw').textContent=w;\n document.getElementById(NS+'-sr').textContent=TOTAL-ans;\n document.getElementById(NS+'-sn').textContent=net>0?'+'+net:net;\n document.getElementById(NS+'-sm').textContent=MAX;\n document.getElementById(NS+'-fill').style.width=(ans\/TOTAL*100)+'%';\n}\n\nfunction showScore(){\n if(sub)return;sub=true;stopTimer();\n document.getElementById(NS+'-tbtn').textContent='\u23f1 Submitted';\n document.getElementById(NS+'-tbtn').classList.remove('run');\n var c=Object.values(ua).filter(function(v){return v==='c';}).length;\n var w=Object.values(ua).filter(function(v){return v==='w';}).length;\n var sk=TOTAL-ans,net=c*4-w;\n var pct=Math.max(0,Math.round(net\/MAX*100));\n var d=Math.min(100,Math.max(0,pct));\n document.getElementById(NS+'-ring').style.background='conic-gradient(var(--teal) '+d+'%,var(--line) 0%)';\n document.getElementById(NS+'-rp').textContent=pct+'%';\n document.getElementById(NS+'-nl').textContent='Net Score: '+net+' \/ '+MAX;\n var v=pct>=80?'Excellent \u2014 well above the qualifying threshold.':pct>=60?'Good attempt \u2014 consolidate the weaker areas.':pct>=40?'Fair \u2014 systematic revision recommended.':'Needs significant revision across these topics.';\n document.getElementById(NS+'-vd').textContent=v;\n document.getElementById(NS+'-bc').textContent='\u2705 '+c+' Correct';\n document.getElementById(NS+'-bw').textContent='\u274c '+w+' Wrong';\n document.getElementById(NS+'-bs').textContent='\u23ed '+sk+' Skipped';\n var sc=document.getElementById(NS+'-sc-box');sc.style.display='block';sc.scrollIntoView({behavior:'smooth',block:'center'});\n}\n\nfunction init(){\n document.getElementById(NS+'-gnow').addEventListener('click',function(){hideGrace();showScore();});\n document.getElementById(NS+'-tbtn').addEventListener('click',function(){if(!tr&&!sub)startTimer();});\n document.getElementById(NS+'-sub').addEventListener('click',showScore);\n document.getElementById(NS+'-retry').addEventListener('click',function(){build();window.scrollTo({top:0,behavior:'smooth'});});\n new IntersectionObserver(function(e){document.getElementById(NS+'-sb').classList.toggle('vis',!e[0].isIntersecting);},{threshold:0}).observe(document.getElementById(NS+'-sen'));\n build();stats();\n}\nif(document.readyState==='loading'){document.addEventListener('DOMContentLoaded',init);}else{init();}\n})();\n<\/script>\n<\/body>\n<\/html>\n\n\n","protected":false},"excerpt":{"rendered":"<p>CMS 2019 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2019Paper 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-36827","post","type-post","status-publish","format-standard","hentry","category-cms","category-obg"],"yoast_head":"\n<title>CMS 2019 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\/13\/cms-2019-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 2019 P2 Part-B OBG - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2019 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2019Paper 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\" \/>\n<meta property=\"og:url\" content=\"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/\" \/>\n<meta property=\"og:site_name\" content=\"atsixty\" \/>\n<meta property=\"article:published_time\" content=\"2026-05-13T04:44:21+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-05-13T04:44:43+00:00\" \/>\n<meta name=\"author\" content=\"Avi\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Avi\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\"},\"author\":{\"name\":\"Avi\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"headline\":\"CMS 2019 P2 Part-B OBG\",\"datePublished\":\"2026-05-13T04:44:21+00:00\",\"dateModified\":\"2026-05-13T04:44:43+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\"},\"wordCount\":54,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"articleSection\":[\"CMS\",\"OBG\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\",\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\",\"name\":\"CMS 2019 P2 Part-B OBG - atsixty\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\"},\"datePublished\":\"2026-05-13T04:44:21+00:00\",\"dateModified\":\"2026-05-13T04:44:43+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/2026\\\/05\\\/13\\\/cms-2019-p2-part-b-obg\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/atsixty.com\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"CMS 2019 P2 Part-B OBG\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/#website\",\"url\":\"https:\\\/\\\/atsixty.com\\\/\",\"name\":\"At Sixty\",\"description\":\"The Option Taken\",\"publisher\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/atsixty.com\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Person\",\"Organization\"],\"@id\":\"https:\\\/\\\/atsixty.com\\\/#\\\/schema\\\/person\\\/cf65e7ac7d8226d95c0bdf1036f7951d\",\"name\":\"Avi\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"url\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"contentUrl\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\",\"width\":200,\"height\":200,\"caption\":\"Avi\"},\"logo\":{\"@id\":\"https:\\\/\\\/atsixty.com\\\/wp-content\\\/uploads\\\/2025\\\/08\\\/logo-agency.png\"},\"sameAs\":[\"https:\\\/\\\/atsixty.com\"],\"url\":\"https:\\\/\\\/atsixty.com\\\/index.php\\\/author\\\/avinaux\\\/\"}]}<\/script>\n","yoast_head_json":{"title":"CMS 2019 P2 Part-B OBG - atsixty","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/","og_locale":"en_US","og_type":"article","og_title":"CMS 2019 P2 Part-B OBG - atsixty","og_description":"CMS 2019 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0 \/ 160 Time's Up! Submitting in 10 Submit Now Combined Medical Services Examination 2019Paper 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","og_url":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/","og_site_name":"atsixty","article_published_time":"2026-05-13T04:44:21+00:00","article_modified_time":"2026-05-13T04:44:43+00:00","author":"Avi","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Avi","Est. reading time":"1 minute"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/#article","isPartOf":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/"},"author":{"name":"Avi","@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"headline":"CMS 2019 P2 Part-B OBG","datePublished":"2026-05-13T04:44:21+00:00","dateModified":"2026-05-13T04:44:43+00:00","mainEntityOfPage":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/"},"wordCount":54,"commentCount":0,"publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"articleSection":["CMS","OBG"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/","url":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/","name":"CMS 2019 P2 Part-B OBG - atsixty","isPartOf":{"@id":"https:\/\/atsixty.com\/#website"},"datePublished":"2026-05-13T04:44:21+00:00","dateModified":"2026-05-13T04:44:43+00:00","breadcrumb":{"@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/atsixty.com\/index.php\/2026\/05\/13\/cms-2019-p2-part-b-obg\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/atsixty.com\/"},{"@type":"ListItem","position":2,"name":"CMS 2019 P2 Part-B OBG"}]},{"@type":"WebSite","@id":"https:\/\/atsixty.com\/#website","url":"https:\/\/atsixty.com\/","name":"At Sixty","description":"The Option Taken","publisher":{"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/atsixty.com\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Person","Organization"],"@id":"https:\/\/atsixty.com\/#\/schema\/person\/cf65e7ac7d8226d95c0bdf1036f7951d","name":"Avi","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","url":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","contentUrl":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png","width":200,"height":200,"caption":"Avi"},"logo":{"@id":"https:\/\/atsixty.com\/wp-content\/uploads\/2025\/08\/logo-agency.png"},"sameAs":["https:\/\/atsixty.com"],"url":"https:\/\/atsixty.com\/index.php\/author\/avinaux\/"}]}},"_links":{"self":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36827","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/comments?post=36827"}],"version-history":[{"count":1,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36827\/revisions"}],"predecessor-version":[{"id":36828,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/posts\/36827\/revisions\/36828"}],"wp:attachment":[{"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/media?parent=36827"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/categories?post=36827"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/atsixty.com\/index.php\/wp-json\/wp\/v2\/tags?post=36827"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}