CMS 2025 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#cms25p2b*,#cms25p2b *::before,#cms25p2b *::after{box-sizing:border-box;margin:0;padding:0}\n#cms25p2b{--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#cms25p2b .sen{height:1px}\n#cms25p2b .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 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0%,var(--line) 0%);display:flex;align-items:center;justify-content:center;margin:0 auto 20px;position:relative}\n#cms25p2b .ring::before{content:'';position:absolute;width:86px;height:86px;border-radius:50%;background:var(--white)}\n#cms25p2b .ri{position:relative;display:flex;flex-direction:column;align-items:center;line-height:1.2}\n#cms25p2b .rp{font-family:'Playfair Display',serif;font-size:1.3rem;font-weight:700;color:var(--teal)}\n#cms25p2b .rs{font-size:.6rem;color:var(--ink-soft);text-transform:uppercase;letter-spacing:.05em}\n#cms25p2b .sc h2{font-family:'Playfair Display',serif;font-size:1.2rem;color:var(--ink);margin-bottom:8px}\n#cms25p2b .nl{font-size:1rem;color:var(--teal);font-weight:600;margin-bottom:6px}\n#cms25p2b .vd{font-size:.85rem;color:var(--ink-soft);margin-bottom:20px}\n#cms25p2b .bands{display:flex;justify-content:center;gap:10px;flex-wrap:wrap;font-size:.8rem}\n#cms25p2b .band{padding:4px 12px;border-radius:16px;font-weight:600}\n#cms25p2b .bc{background:var(--cb-bg);color:#1e6f46}\n#cms25p2b .bw{background:var(--wb-bg);color:var(--wb)}\n#cms25p2b .bs{background:var(--teal-pale);color:var(--teal)}\n#cms25p2b .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#cms25p2b .rbtn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){#cms25p2b .hdr h1{font-size:1.15rem}#cms25p2b .qt{font-size:.88rem}#cms25p2b .ot{font-size:.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms25p2b\">\n<div class=\"sen\" id=\"cms25p2b-sen\"><\/div>\n<div class=\"sb\" id=\"cms25p2b-sb\">\n <div class=\"sb-row\">\n <div class=\"ti\" id=\"cms25p2b-ti\">\u23f1 <strong id=\"cms25p2b-td\">40:00<\/strong><\/div>\n <div class=\"sb-it\">\u2705 <strong id=\"cms25p2b-sc\">0<\/strong><\/div>\n <div class=\"sb-it\">\u274c <strong id=\"cms25p2b-sw\">0<\/strong><\/div>\n <div class=\"sb-it\">\u23f3 <strong id=\"cms25p2b-sr\">40<\/strong> left<\/div>\n <div class=\"sb-sep\"><\/div>\n <div class=\"sb-it\">Net <strong id=\"cms25p2b-sn\">0.00<\/strong> \/ <strong id=\"cms25p2b-sm\">40<\/strong><\/div>\n <\/div>\n <div class=\"sb-bar\"><div class=\"sb-fill\" id=\"cms25p2b-fill\"><\/div><\/div>\n<\/div>\n<div class=\"grace\" id=\"cms25p2b-grace\">\n <div class=\"gb\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"gc\" id=\"cms25p2b-gc\">10<\/div>\n <button class=\"gnow\" id=\"cms25p2b-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"hdr\">\n <h1>Combined Medical Services Examination 2025<br>Paper II \u00b7 Part B<\/h1>\n <p>Gynaecology & Obstetrics (Q41 \u2013 Q80)<\/p>\n <div class=\"meta\">\n <span class=\"bdg\">Questions 41 \u2013 80<\/span>\n <span class=\"bdg\">+1 correct \u00b7 \u2212\u2153 wrong<\/span>\n <button class=\"tbtn\" id=\"cms25p2b-tbtn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"body\">\n <div id=\"cms25p2b-qs\"><\/div>\n <div class=\"sw\"><button class=\"btn\" id=\"cms25p2b-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms25p2b-sc-box\">\n <div class=\"ring\" id=\"cms25p2b-ring\"><div class=\"ri\"><span class=\"rp\" id=\"cms25p2b-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms25p2b-nl\"><\/div>\n <div class=\"vd\" id=\"cms25p2b-vd\"><\/div>\n <div class=\"bands\">\n <span class=\"band bc\" id=\"cms25p2b-bc\"><\/span>\n <span class=\"band bw\" id=\"cms25p2b-bw\"><\/span>\n <span class=\"band bs\" id=\"cms25p2b-bs\"><\/span>\n <\/div>\n <button class=\"rbtn\" id=\"cms25p2b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms25p2b',TOTAL=40,MAX=40,TSECS=2400,GSECS=10;\nvar CU=100,WU=33;\nvar QS=[\n{id:41,stem:'Chadwick\\'s sign describes:',correct:'the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy',options:['the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy','softening of cervix at 6th week of pregnancy','the abdominal and vaginal fingers apposed below the body of the uterus during bimanual examination','regular and rhythmic uterine contraction which can be elicited during bimanual examination at 4-8 weeks of pregnancy'],exp:'Signs of pregnancy \u2014 identification: CHADWICK\\'S SIGN \u2714 \u2014 the dusky, violet\/bluish-purple discolouration of the VESTIBULE and anterior vaginal wall (and cervix) visible from about 6\u20138 weeks of pregnancy; caused by increased vascularity and venous congestion of pelvic organs. Other options: Goodell\\'s sign: softening of the cervix (from ~6th week). Hegar\\'s sign: softening of the isthmus of the uterus; abdominal and vaginal fingers can be almost apposed below the body of the uterus during bimanual examination (~6\u20138 weeks). Braxton Hicks: irregular, painless uterine contractions; Piskacek\\'s sign involves the asymmetric enlargement. Regular rhythmic contractions = true labour or Braxton Hicks. Answer: Dusky hue of vestibule and anterior vaginal wall at about 8th week.'},\n{id:42,stem:'Which of the following treatments are recommended for a pregnant woman suffering from sickle cell disease?\\nI. Folic acid 1 mg daily\\nII. Azathioprine\\nIII. Penicillin prophylaxis\\nIV. Thromboprophylaxis with low molecular weight heparin\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Sickle cell disease in pregnancy \u2014 management: FOLIC ACID 1 mg daily \u2714 \u2014 increased folate demand due to haemolysis and rapid cell turnover; essential to prevent megaloblastic anaemia; 5 mg daily may be preferred in some guidelines. AZATHIOPRINE \u2717 \u2014 immunosuppressant; NOT used in sickle cell disease management during pregnancy; has teratogenic potential. PENICILLIN PROPHYLAXIS \u2714 \u2014 sickle cell disease causes functional asplenia \u2192 susceptibility to encapsulated organisms; penicillin prophylaxis recommended throughout life including pregnancy. THROMBOPROPHYLAXIS WITH LMWH \u2714 \u2014 pregnancy + sickle cell disease = very high thrombotic risk; LMWH thromboprophylaxis recommended throughout pregnancy and 6 weeks postpartum. Also: hydroxyurea is stopped before\/during pregnancy; regular blood transfusions as needed. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:43,stem:'Which of the following are contraindications to External Cephalic Version (ECV) in breech?\\nI. Pregnancy less than 36 weeks\\nII. Multiple pregnancy\\nIII. Previous caesarean delivery\\nIV. Rhesus isoimmunisation\\nSelect the correct answer:',correct:'I, II and IV',options:['I, III and IV','II, III and IV','I, II and IV','I, II and III'],exp:'ECV contraindications: Statement I \u2714 \u2014 Pregnancy <36 weeks: ECV is performed at \u226536 weeks (term); before this gestation the fetus may spontaneously turn and there is greater risk of preterm labour. Statement II \u2714 \u2014 MULTIPLE PREGNANCY: absolute contraindication; manipulating one twin risks the co-twin, cord entanglement, and premature labour. Statement III \u2717 \u2014 PREVIOUS CAESAREAN SECTION: this is a RELATIVE contraindication in some guidelines (risk of uterine scar rupture during ECV); but most current guidelines (RCOG) do not list it as an absolute contraindication; ECV can be offered with informed consent. Statement IV \u2714 \u2014 RHESUS ISOIMMUNISATION: ECV causes fetomaternal haemorrhage \u2192 in Rh-negative sensitised mothers, additional immunisation worsens the existing antibody titre; contraindicated. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:44,stem:'Which of the following haematological findings are seen in pregnant women with thalassaemia trait?',correct:'Raised HbA\u2082 and low MCV',options:['Raised HbA\u2082 and low MCV','Low MCHC','Low serum total iron binding capacity','Low HbA\u2082 and raised MCV'],exp:'Beta-thalassaemia trait (carrier state) \u2014 haematological features: RAISED HbA\u2082 \u2714 \u2014 HbA\u2082 (\u03b1\u2082\u03b4\u2082) is elevated (>3.5%, usually 4\u20137%); this is the DIAGNOSTIC HALLMARK of beta-thalassaemia trait; elevated because beta chains are reduced so delta chains compensate. LOW MCV (microcytosis) \u2714 \u2014 small red cells; hypochromic; due to reduced beta globin chain synthesis \u2192 reduced Hb per cell. Also: low MCH, mild anaemia (Hb 10\u201312 g\/dL), target cells, normal\/low serum ferritin (unlike iron deficiency). MCHC: may be low or normal. TIBC: normal (not reduced \u2014 that would suggest iron overload). MCV is LOW not raised (raised MCV suggests B12\/folate deficiency or macrocytosis). Answer: Raised HbA\u2082 and low MCV.'},\n{id:45,stem:'The best drug for maintenance therapy of Systemic Lupus Erythematosus (SLE) during pregnancy is:',correct:'Hydroxychloroquine',options:['Hydroxychloroquine','Sulfasalazine','Tacrolimus','Progestins'],exp:'SLE in pregnancy \u2014 maintenance therapy: HYDROXYCHLOROQUINE (HCQ) \u2714 \u2014 the cornerstone of SLE maintenance during pregnancy. Reasons: (1) Reduces lupus flares during pregnancy; (2) Reduces risk of neonatal lupus and congenital heart block; (3) Safe in pregnancy (no teratogenicity established); (4) Reduces risk of pre-eclampsia and thrombosis in antiphospholipid antibody-positive patients. Continuing HCQ throughout pregnancy is strongly recommended by ACR\/EULAR. Sulfasalazine: used in SLE\/rheumatoid arthritis but not the first-line maintenance; less evidence. Tacrolimus: calcineurin inhibitor; used in renal SLE\/lupus nephritis but not standard maintenance. Progestins: no role in SLE maintenance. Answer: Hydroxychloroquine.'},\n{id:46,stem:'Which of the following maternal complications can be seen in hyperemesis gravidarum?\\nI. Wernicke\\'s encephalopathy\\nII. Hepatic failure\\nIII. Hypoprothrombinemia\\nIV. Convulsions\\nSelect the correct answer:',correct:'I, II and IV only',options:['I, II, III and IV','I, III and IV only','I, II and IV only','II and III only'],exp:'Hyperemesis gravidarum (HG) \u2014 maternal complications: WERNICKE\\'S ENCEPHALOPATHY \u2714 \u2014 thiamine (B1) deficiency from prolonged vomiting and poor intake \u2192 Wernicke\\'s (ophthalmoplegia, ataxia, confusion); thiamine must be supplemented before\/with IV dextrose. HEPATIC FAILURE \u2714 \u2014 severe HG can cause transient LFT derangement and in extreme cases hepatic dysfunction\/failure; liver involvement occurs in ~50% of severe HG. CONVULSIONS \u2714 \u2014 from severe electrolyte disturbances (hyponatraemia \u2192 seizures) and Wernicke\\'s encephalopathy. HYPOPROTHROMBINEMIA \u2717 \u2014 while malnutrition can affect coagulation factors long-term, hypoprothrombinemia is NOT a recognised\/typical complication of HG specifically. Official answer: I, II and IV. Answer: I, II and IV only.'},\n{id:47,stem:'The commonest ovarian tumour seen during pregnancy is:',correct:'Benign cystic teratoma',options:['Benign cystic teratoma','Mucinous cystadenoma','Endometrioma','Adenocarcinoma ovary'],exp:'Ovarian tumours in pregnancy: BENIGN CYSTIC TERATOMA (dermoid cyst) \u2714 \u2014 the MOST COMMON ovarian tumour found during pregnancy; accounts for ~35\u201340% of all ovarian masses in pregnancy. Dermoid cysts are germ cell tumours containing ectodermal elements (skin, hair, teeth, sebaceous material). They are typically unilateral, mobile, and identified incidentally on routine obstetric ultrasound. Risk: torsion (most common complication in pregnancy). Also common: mucinous cystadenoma (second most common), serous cystadenoma. Endometrioma: can occur during pregnancy but less common. Adenocarcinoma: rare (~1 in 18,000 pregnancies). Answer: Benign cystic teratoma.'},\n{id:48,stem:'Which of the following statements are correct regarding shoulder dystocia?\\nI. It can be predicted during early labour\\nII. Anencephaly is a risk factor\\nIII. Turtle neck sign is present\\nIV. Episiotomy should always be given\\nSelect the answer:',correct:'II and III only',options:['I, II and III','I, II and IV','II and III only','I, III and IV'],exp:'Shoulder dystocia: Statement I \u2717 \u2014 Shoulder dystocia CANNOT be reliably predicted; while risk factors exist (macrosomia, GDM, previous shoulder dystocia, prolonged second stage), the majority of cases occur without identifiable risk factors; it is largely unpredictable. Statement II \u2714 \u2014 ANENCEPHALY is a risk factor; the absence of the skull means the head delivers easily but the shoulders are proportionally wider \u2192 relative shoulder dystocia; also any condition with macrosomia or short fetal trunk. Statement III \u2714 \u2014 TURTLE NECK SIGN (retraction sign): after delivery of the head, it retracts back against the perineum (like a turtle retreating into its shell); pathognomonic of shoulder dystocia. Statement IV \u2717 \u2014 Episiotomy does NOT relieve bony shoulder dystocia; shoulders are impacted at the bony pelvic inlet; episiotomy creates more soft tissue room (for manoeuvres like Woods screw) but is NOT always required and is NOT the primary treatment. Correct: II and III. Answer: II and III only.'},\n{id:49,stem:'A primigravida at 38 weeks pregnancy was put on oxytocin drip in view of slow labour at the rate of 30 mIU\/min by the newly appointed registrar. She complains of confusion and starts throwing fits. What electrolyte imbalance is expected to have happened in this case?',correct:'Hyponatremia',options:['Hypokalemia','Hyponatremia','Hypocalcemia','Hypernatremia'],exp:'OXYTOCIN at HIGH DOSES (30 mIU\/min is excessive \u2014 standard maximum is 20\u201340 mIU\/min but with careful monitoring) \u2192 ANTIDIURETIC EFFECT: oxytocin is structurally similar to ADH (vasopressin); at high doses it acts as an antidiuretic \u2192 water retention \u2192 dilutional HYPONATRAEMIA. Features of water intoxication\/hyponatraemia: confusion, headache, CONVULSIONS (fits) \u2714, coma, pulmonary oedema. Risk factors: large volumes of hypotonic IV fluids + high-dose oxytocin infusion. Prevention: use isotonic saline (not 5% dextrose) as oxytocin carrier; limit fluid intake; monitor urine output and sodium. Answer: Hyponatremia.'},\n{id:50,stem:'Which of the following factors favour posterior position of the vertex?\\nI. Anthropoid pelvis\\nII. Low inclination pelvis\\nIII. Attachment of placenta on the anterior wall\\nIV. Primary brachycephaly\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Factors favouring OCCIPITO-POSTERIOR (OP) position: ANTHROPOID PELVIS \u2714 \u2014 oval AP diameter > transverse; the long AP diameter accommodates the head in the AP diameter with occiput posterior; most OP positions occur in anthropoid pelvis. ANTERIOR PLACENTA \u2714 \u2014 placenta on anterior uterine wall takes up space anteriorly \u2192 fetal back (and occiput) is pushed posteriorly; consistently associated with OP position. PRIMARY BRACHYCEPHALY \u2714 \u2014 a broad, short head shape (brachycephalic skull) tends to enter in the OP position. LOW INCLINATION PELVIS \u2717 \u2014 a pelvis with low inclination (flat\/platypelloid type) favours a TRANSVERSE engagement; the platypelloid pelvis with wide transverse diameter favours OT, not OP position. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:51,stem:'Which of the following factors are associated with cord prolapse during labour?\\nI. Malpresentations\\nII. Contracted pelvis\\nIII. Stabilising induction\\nIV. Prematurity\\nSelect the correct answer:',correct:'I, II, III and IV',options:['I, II, III and IV','I, II and IV only','I, II and III only','III and IV only'],exp:'Umbilical cord prolapse \u2014 risk factors: MALPRESENTATIONS \u2714 \u2014 breech, transverse lie, oblique lie, footling breech \u2192 the presenting part does not fit snugly into the pelvis \u2192 space for cord to prolapse. CONTRACTED PELVIS \u2714 \u2014 a contracted\/flat pelvis \u2192 poor engagement \u2192 space between presenting part and pelvic brim \u2192 cord can slip through. STABILISING INDUCTION (induction when head is high\/unengaged) \u2714 \u2014 performing AROM (amniotomy) when the head is not engaged \u2192 sudden rush of liquor carries the cord down \u2192 cord prolapse; this is a recognised iatrogenic cause. PREMATURITY \u2714 \u2014 preterm fetuses are small \u2192 poor fit of presenting part to the pelvis \u2192 increased risk of cord prolapse. All four are established risk factors. Answer: I, II, III and IV.'},\n{id:52,stem:'Detection of magnesium toxicity in a patient receiving magnesium sulphate is noticed by which of the following?\\nI. Loss of tendon reflexes\\nII. Increased respiratory rate\\nIII. Chest pain, heart block\\nIV. Cardiac arrest\\nSelect the correct answer:',correct:'I, III and IV',options:['I, III and IV','II and IV only','I and III only','III and IV only'],exp:'Magnesium sulphate toxicity \u2014 sequence with increasing serum levels: 4\u20137 mEq\/L (therapeutic): anticonvulsant effect, mild nausea. 7\u201310 mEq\/L: LOSS OF PATELLAR TENDON REFLEXES \u2714 (Statement I \u2014 first clinical sign of toxicity; MONITOR reflexes hourly). 10\u201313 mEq\/L: respiratory depression (DECREASED not increased respiratory rate \u2717 \u2014 Statement II says INCREASED which is WRONG). 13\u201315 mEq\/L: RESPIRATORY PARALYSIS. 15+ mEq\/L: CARDIAC CONDUCTION DEFECTS, HEART BLOCK \u2714 (Statement III). CARDIAC ARREST \u2714 (Statement IV \u2014 at very high levels). Statement II \u2717 \u2014 magnesium toxicity causes respiratory DEPRESSION (slowed rate), NOT increased respiratory rate. Correct: I, III, IV. Antidote: calcium gluconate 1g IV. Answer: I, III and IV.'},\n{id:53,stem:'Which one of the following is correct regarding postpartum psychosis?',correct:'Recurrence rate in subsequent pregnancy is 60-70%.',options:['There is often no family history of psychosis.','Its onset is usually within 4 days of delivery.','Recurrence rate in subsequent pregnancy is 60-70%.','Electro convulsive therapy is the first treatment of choice.'],exp:'Postpartum psychosis (puerperal psychosis): Option a \u2717 \u2014 there IS often a POSITIVE family history of psychosis (especially bipolar disorder); genetic predisposition is strong; 50% have a personal or family history of bipolar\/schizophrenia. Option b \u2717 \u2014 onset is typically within 2 WEEKS, most commonly within the first WEEK (days 3\u201314); \"within 4 days\" is too specific\/restrictive. Option c \u2714 \u2014 RECURRENCE RATE in subsequent pregnancies is HIGH: 60\u201370% (some sources say 50\u201380%); women with a history of puerperal psychosis have very high risk of recurrence with subsequent pregnancies and must be counselled and monitored. Option d \u2717 \u2014 FIRST treatment of choice is antipsychotic medication (haloperidol, olanzapine) \u00b1 mood stabiliser; ECT is reserved for SEVERE, treatment-resistant cases or when rapid response is critical. Answer: Recurrence rate in subsequent pregnancy is 60-70%.'},\n{id:54,stem:'Which of the following are correct in the treatment of cracked nipple?\\nI. Correct attachment (Latch on) will provide immediate relief from pain and rapid healing\\nII. If pain, mother should use breast pump and the infant is fed with the expressed milk\\nIII. Miconazole lotion is applied over the nipple as well as in the baby\\'s mouth if there is oral thrush\\nSelect the answer:',correct:'I, II and III',options:['I and II only','II and III only','I and III only','I, II and III'],exp:'Cracked nipple management: Statement I \u2714 \u2014 CORRECT ATTACHMENT\/LATCH is the PRIMARY treatment; most cracked nipples result from poor latching technique; correct positioning \u2192 baby takes a large amount of areola \u2192 no nipple trauma \u2192 pain relief and healing. Statement II \u2714 \u2014 If pain is severe and breastfeeding too painful: temporarily use BREAST PUMP to express milk \u2192 feed expressed breast milk by cup\/spoon \u2192 maintains milk supply while nipple heals. Statement III \u2714 \u2014 If ORAL THRUSH (Candida) is present in the baby\\'s mouth, it can infect the mother\\'s nipple (Candidal mastitis\/nipple infection); treatment: MICONAZOLE GEL\/LOTION applied to BOTH the nipple AND inside the baby\\'s mouth simultaneously (to prevent ping-pong infection). All three statements are correct. Answer: I, II and III.'},\n{id:55,stem:'Which of the following are correct regarding puerperal blues?\\nI. Its incidence is around 50%\\nII. There is no specific metabolic or endocrine derangement\\nIIII. Treatment is reassurance and psychological support\\nSelect the answer:',correct:'I, II and III',options:['I and II only','II and III only','I and III only','I, II and III'],exp:'Puerperal (baby) blues: INCIDENCE \u2714 \u2014 affects approximately 50\u201380% of all mothers (some sources say 30\u201375%; \"around 50%\" is widely quoted and considered correct). AETIOLOGY \u2714 \u2014 no SPECIFIC metabolic or endocrine cause identified; despite occurring during the rapid hormonal withdrawal (oestrogen\/progesterone\/prolactin changes), no consistent specific endocrine derangement has been demonstrated; multifactorial (fatigue, emotional adjustment, hormonal changes). TREATMENT \u2714 \u2014 REASSURANCE and PSYCHOLOGICAL\/EMOTIONAL SUPPORT are the mainstay; puerperal blues is self-limiting (resolves within 10\u201314 days); no specific pharmacotherapy required; if persists beyond 2 weeks \u2192 screen for postnatal depression. All three correct. Answer: I, II and III.'},\n{id:56,stem:'The Matthews Duncan process has been described for:',correct:'marginal separation of placenta in normal labour',options:['marginal separation of placenta in normal labour','central separation of placenta in normal labour','controlled contraction in active management of third stage of labour','reposition of acute inversion of uterus following vaginal delivery'],exp:'Placental separation mechanisms: SCHULTZE METHOD (central separation): placenta separates from the centre first \u2192 fetal surface delivers first (shiny, smooth side); blood trapped behind placenta. MATTHEWS DUNCAN METHOD \u2714 \u2014 MARGINAL SEPARATION: the placenta separates from the lower edge\/margin first \u2192 slides down and emerges sideways (like a button being pushed through a buttonhole); maternal (raw) surface presents first; blood trickles around the edge and drips out during separation. More common with lower-segment placentas. Associated with more blood loss than Schultze. Answer: Marginal separation of placenta in normal labour.'},\n{id:57,stem:'A PILI lady after 4 hours of delivery is suffering from persistent, severe pain in the perineal region, rectal tenesmus, bearing down feeling and retention of urine. The probable diagnosis is:',correct:'Supralevator hematoma',options:['Cervical tear','Vulval hematoma','Supralevator hematoma','Complete perineal tear'],exp:'POST-PARTUM HAEMATOMA \u2014 differential by site: VULVAL HAEMATOMA: visible swelling in labia\/vulva; severe perineal pain; variable urinary retention; visible\/palpable. PARAVAGINAL\/INFRALEVATOR: vaginal pain, swelling visible on examination. SUPRALEVATOR HAEMATOMA \u2714 \u2014 above the levator ani; blood tracks into the broad ligament\/retroperitoneal space; features: SEVERE PERINEAL PAIN + RECTAL TENESMUS (pressure on rectum) + BEARING DOWN FEELING + URINARY RETENTION (pressure on bladder); NO visible swelling externally; insidious; can be life-threatening. Cervical tear: postpartum haemorrhage, bright red bleeding; no haematoma. Complete perineal tear: visible tear through sphincter\/rectum; rectal examination reveals the tear. The clinical picture of deep pressure symptoms with NO external swelling = supralevator haematoma. Answer: Supralevator hematoma.'},\n{id:58,stem:'According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage of labour?',correct:'Duration of latent phase of primigravida has not been established',options:['Duration of latent phase of primigravida has not been established','Duration of active stage of multigravida should not exceed 6 hours','Duration of active stage of primigravida should not exceed 8 hours','Duration of active stage of primigravida should not exceed 18 hours'],exp:'WHO Intrapartum Care Guidelines 2018 \u2014 first stage of labour: LATENT PHASE: WHO 2018 states that the DURATION OF THE LATENT PHASE HAS NOT BEEN ESTABLISHED \u2714 \u2014 the latent phase length is highly variable and cannot be reliably defined; women should not be admitted routinely in the latent phase. ACTIVE PHASE (from 5 cm dilatation per WHO 2018): the active phase is defined as starting from 5 cm (not the older 3\u20134 cm definition). Duration: active phase in primigravida should progress at \u22650.5\u20131 cm\/hour; no fixed maximum duration is specified in the 2018 guidelines based on time alone. \"Should not exceed 8 hours\" (option c) is an older guideline figure. \"Not exceed 6 hours\" for multigravida: not specifically stated. Answer: Duration of latent phase of primigravida has not been established.'},\n{id:59,stem:'According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position?\\nI. For a woman without epidural analgesia, adoption of birthing position is individual woman\\'s choice\\nII. For a woman without epidural analgesia, upright birthing position may be adopted\\nIII. For a woman with epidural analgesia, lithotomy and supine position only are recommended\\nSelect the answer:',correct:'I and II only',options:['I and II only','II and III only','I and III only','I, II and III'],exp:'WHO Intrapartum Care Guidelines 2018 \u2014 birthing positions: Statement I \u2714 \u2014 For women WITHOUT epidural analgesia: WOMAN\\'S OWN CHOICE of birthing position is recommended; no position should be imposed. Statement II \u2714 \u2014 UPRIGHT position (sitting, squatting, kneeling, standing) may be adopted; WHO encourages upright positions which have benefits (shorter second stage, reduced episiotomy, fewer assisted deliveries). Statement III \u2717 \u2014 FALSE. For women WITH epidural analgesia: WHO does NOT recommend ONLY lithotomy and supine; lateral (left lateral) position is also acceptable and preferred over supine; supine\/lithotomy is NOT exclusively recommended. \"Only lithotomy and supine\" is an overly restrictive statement not aligned with WHO 2018 recommendations. Correct: I and II. Answer: I and II only.'},\n{id:60,stem:'Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following?\\nI. Number of foetus\\nII. Viability of foetus\\nIII. Chorionicity of twins\\nIV. Malformation in either foetus\\nSelect the correct answer:',correct:'I, II and III only',options:['I, II and III only','I and III only','II and IV only','I, II, III and IV'],exp:'First trimester ultrasound (10\u201313+6 weeks) in twin pregnancy: NUMBER OF FETUSES \u2714 \u2014 confirm the exact number (dichorionic-diamniotic, monochorionic-diamniotic, monoamniotic). VIABILITY \u2714 \u2014 confirm cardiac activity in both; identify vanishing twin. CHORIONICITY AND AMNIONICITY \u2714 \u2014 the MOST IMPORTANT determination; assessed at 10\u201314 weeks by: twin peak (lambda) sign = dichorionic; T-sign = monochorionic; number of placental masses; fetal sex (different sex = dichorionic). Chorionicity determines prognosis and surveillance intensity. MALFORMATION \u2717 \u2014 detailed structural anomaly survey is NOT reliably performed at 10\u201313 weeks (too early for most structural anomalies); the anomaly scan is at 18\u201322 weeks. NT measurement is done at this time but full morphology scan is later. Correct: I, II, III. Answer: I, II and III only.'},\n{id:61,stem:'Which of the following are neonatal complications of maternal diabetes during pregnancy?\\nI. Hyperbilirubinaemia\\nII. Hypercalcaemia\\nIII. Cardiomyopathy\\nIV. Hypoglycaemia\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Neonatal complications of diabetic pregnancy (IDM \u2014 infant of diabetic mother): HYPERBILIRUBINAEMIA \u2714 \u2014 polycythaemia (from erythropoietin stimulation by hypoxia) \u2192 increased RBC breakdown \u2192 jaundice. CARDIOMYOPATHY \u2714 \u2014 hypertrophic obstructive cardiomyopathy (septal hypertrophy) in ~30\u201340% of IDMs; usually resolves; can cause heart failure. HYPOGLYCAEMIA \u2714 \u2014 most common and most dangerous: fetal hyperinsulinaemia (from maternal hyperglycaemia) \u2192 after birth, maternal glucose supply stops but hyperinsulinaemia persists \u2192 neonatal hypoglycaemia; occurs within 1\u20132 hours of birth. HYPERCALCAEMIA \u2717 \u2014 IDMs develop HYPOCALCAEMIA (not hypercalcaemia); decreased PTH, hypomagnesaemia \u2192 neonatal hypocalcaemia \u2192 jitteriness, seizures. Also: macrosomia, respiratory distress syndrome (delayed lung maturation), polycythaemia. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:62,stem:'Which of the following are the predictive factors for Fetal Growth Restriction (FGR)?\\nI. Low level of maternal 1st trimester Beta hCG\\nII. Abnormal uterine artery Doppler at 20-24 weeks of pregnancy\\nIII. Fetal echogenic bowel on ultrasound\\nIV. Maternal medical disorder\\nSelect the correct answer:',correct:'II, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Predictive factors for FGR: Statement I \u2717 \u2014 LOW first trimester beta-hCG is NOT a recognised predictive factor for FGR; LOW PAPP-A (pregnancy-associated plasma protein A) IS a predictor of FGR\/placental dysfunction in first trimester screening. Statement II \u2714 \u2014 ABNORMAL UTERINE ARTERY DOPPLER at 20\u201324 weeks (increased resistance index, bilateral notching) is one of the best predictors of placental insufficiency \u2192 FGR and pre-eclampsia. Statement III \u2714 \u2014 FETAL ECHOGENIC BOWEL on ultrasound is associated with FGR (also associated with cystic fibrosis, chromosomal anomalies, CMV, Down syndrome). Statement IV \u2714 \u2014 MATERNAL MEDICAL DISORDERS: hypertension, diabetes, renal disease, autoimmune conditions (APS, SLE), thrombophilias \u2192 impaired placentation \u2192 FGR. Correct: II, III, IV. Answer: II, III and IV.'},\n{id:63,stem:'Which of the following is the primary surveillance tool in the Growth Restricted Fetus?',correct:'Umbilical artery doppler',options:['Uterine artery doppler','Umbilical venous pulsation','Middle cerebral artery doppler','Umbilical artery doppler'],exp:'FGR surveillance \u2014 primary tool: UMBILICAL ARTERY DOPPLER \u2714 \u2014 measures resistance in the placental circulation; the PRIMARY and FIRST-LINE surveillance tool for FGR. Abnormal findings: absent end-diastolic flow (AEDF) or reversed end-diastolic flow (REDF) \u2192 indicates severe placental insufficiency \u2192 guides timing of delivery. MCA Doppler: secondary tool; MCA-PSV used for fetal anaemia assessment; MCA PI used for \"brain-sparing\" (cerebro-umbilical ratio); second-line in FGR. Uterine artery Doppler: used for PREDICTION of FGR (at 20\u201324 weeks), not primary surveillance once FGR is established. Umbilical venous pulsation: a late, ominous sign of fetal cardiac compromise; used in conjunction with ductus venosus Doppler in late-stage FGR. Answer: Umbilical artery doppler.'},\n{id:64,stem:'Glands of Cloquet are:',correct:'lymphatic drainage of cervix',options:['lymphatic drainage of vulva','lymphatic drainage of cervix','lymphatic drainage of uterus','lubricating glands of vagina'],exp:'Glands\/Nodes of Cloquet (also called Node of Cloquet or Rosenm\u00fcller\\'s node): a group of deep inguinal lymph nodes situated in the femoral canal (between the femoral vein and the lacunar ligament). They receive LYMPHATIC DRAINAGE from: the CERVIX \u2714 (via parametrial and obturator routes to external iliac and then to Cloquet\\'s node), clitoris, glans penis, bladder trigone. Important: a positive Cloquet\\'s node in cervical carcinoma indicates pelvic lymph node metastasis \u2014 surgically significant. Note: Bartholin\\'s glands = lubricating; vulvar lymphatics \u2192 inguinal nodes. Answer: Lymphatic drainage of cervix.'},\n{id:65,stem:'Causes of AUB are subdivided by the acronym PALM-COEIN. What are the characteristics of PALM causes?\\nI. Structural lesions\\nII. Diagnosed by ultrasound\\nIII. Confirmed by histopathology\\nSelect the correct answer:',correct:'I and III only',options:['I and II only','I and III only','I, II and III','II and III only'],exp:'PALM-COEIN classification of AUB (FIGO 2011): PALM = structural causes (visible on imaging or histopathology): P = Polyp, A = Adenomyosis, L = Leiomyoma, M = Malignancy and hyperplasia. CHARACTERISTICS OF PALM: Statement I \u2714 \u2014 STRUCTURAL LESIONS: all PALM causes are structural\/anatomical abnormalities. Statement II \u2717 \u2014 NOT all diagnosed by ultrasound; Malignancy\/hyperplasia (the M in PALM) requires HISTOPATHOLOGICAL confirmation; adenomyosis may need MRI or histology; ultrasound alone is insufficient for all PALM causes. Statement III \u2714 \u2014 CONFIRMED BY HISTOPATHOLOGY: all PALM causes can\/should be confirmed histopathologically (polyp by polypectomy\/biopsy; adenomyosis by hysterectomy specimen; leiomyoma by pathology; malignancy by biopsy). COEIN = functional\/non-structural causes. Correct: I and III. Answer: I and III only.'},\n{id:66,stem:'Daily suppressive therapy for HSV-1 and HSV-2 is:',correct:'Acyclovir 400 mg twice daily',options:['Valacyclovir 1 g once daily','Acyclovir 400 mg once daily','Acyclovir 400 mg thrice daily','Acyclovir 400 mg twice daily'],exp:'Herpes simplex virus (HSV) suppressive therapy regimens: ACYCLOVIR for DAILY SUPPRESSION: 400 mg TWICE DAILY \u2714 \u2014 the standard CDC-recommended regimen for daily suppressive therapy; reduces recurrence frequency by 70\u201380%; reduces asymptomatic viral shedding. Alternative: Acyclovir 200 mg 5 times daily (older regimen). VALACYCLOVIR for suppression: 500 mg once daily OR 1 g once daily (for frequent recurrences). Valacyclovir 1 g once daily = suppressive but not the standard first choice described in this option. \"400 mg once daily\" = insufficient. \"400 mg thrice daily\" = episodic treatment dose. Standard suppressive = Acyclovir 400 mg TWICE daily. Answer: Acyclovir 400 mg twice daily.'},\n{id:67,stem:'Which of the following are the primary organisms involved in PID?\\nI. N. gonorrhoeae\\nII. Chlamydia\\nIII. Mycoplasma hominis\\nIV. Candida albicans\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Pelvic Inflammatory Disease (PID) \u2014 causative organisms: PRIMARY\/MOST IMPORTANT organisms: N. GONORRHOEAE \u2714 \u2014 sexually transmitted; ascends from the cervix; classic cause; gram-negative diplococcus. CHLAMYDIA TRACHOMATIS \u2714 \u2014 most common STI-associated PID organism in many regions; intracellular; often subclinical\/silent; causes tubal scarring. MYCOPLASMA HOMINIS \u2714 \u2014 a vaginal commensal that can ascend and contribute to upper genital tract infection; causes endometritis and salpingitis. Also: Mycoplasma genitalium (increasingly recognised), anaerobes (in more severe\/polymicrobial PID). CANDIDA ALBICANS \u2717 \u2014 Candida causes vulvovaginal CANDIDIASIS (thrush); it does NOT cause PID; it is a fungus not a bacterium and does not ascend to cause salpingitis. Correct: I, II, III. Answer: I, II and III.'},\n{id:68,stem:'What are the characteristics of dermoid cyst?\\nI. Germ cell ovarian tumour\\nII. Bilateral in 15-20% cases\\nIII. Torsion is common\\nIV. Rupture is common\\nSelect the correct answer:',correct:'I, II and III',options:['I and III only','II and IV only','II, III and IV','I, II and III'],exp:'Dermoid cyst (mature cystic teratoma) characteristics: Statement I \u2714 \u2014 GERM CELL tumour: derived from totipotential germ cells; contains ectodermal structures (skin, hair, sebaceous glands, teeth); most common benign ovarian tumour in young women. Statement II \u2714 \u2014 BILATERAL in 10\u201315% (some sources say up to 20%) of cases; important to examine the opposite ovary at surgery. Statement III \u2714 \u2014 TORSION is COMMON: dermoid cysts are prone to torsion because they are heavy (dense contents) and usually pedunculated\/mobile; torsion = most common complication (occurs in ~15%). Statement IV \u2717 \u2014 RUPTURE is NOT common (rare complication); rupture can cause chemical peritonitis from spilled sebaceous material; it is serious when it occurs but is uncommon. Correct: I, II, III. Answer: I, II and III.'},\n{id:69,stem:'Which one of the following is NOT a differential diagnosis of chronic inversion of uterus?',correct:'Gartner\\'s cyst',options:['Fibroid polyp','Fungating cervical malignancy','Cervical prolapse','Gartner\\'s cyst'],exp:'Chronic inversion of uterus \u2014 differential diagnoses (conditions that present as a mass protruding from the cervix\/vagina): FIBROID POLYP \u2714 \u2014 a submucous fibroid on a long pedicle can prolapse through the cervix; the mass feels firm, smooth; clinically similar to inversion. FUNGATING CERVICAL MALIGNANCY \u2714 \u2014 exophytic, friable, bleeding mass at the cervix; can mimic uterine inversion. CERVICAL PROLAPSE \u2714 \u2014 the cervix (and uterus) descends and protrudes from the vaginal introitus; palpation shows the mass is the cervix with uterus attached above. GARTNER\\'S CYST \u2717 \u2014 a remnant of the mesonephric (Wolffian) duct; appears as a small CYSTIC swelling on the ANTEROLATERAL VAGINAL WALL; it does NOT present as a mass prolapsing from the cervix; NOT a differential of uterine inversion. Answer: Gartner\\'s cyst.'},\n{id:70,stem:'A 28-year-old P\u2082L\u2082 presents to Gynaecology OPD with complaints of malodorous vaginal discharge. On examination, the discharge was found to be grayish-white in colour and adherent to vaginal walls. Which one of the following is a bedside diagnostic criterion for the causative organism?',correct:'Positive 10% potassium hydroxide test',options:['Presence of RBCs in vaginal smear','Vaginal pH < 4.5','Positive 10% potassium hydroxide test','Positive NAAT test'],exp:'Bacterial Vaginosis (BV): grayish-white, homogeneous, malodorous discharge adherent to vaginal walls. Amsel\\'s criteria (3 of 4 for diagnosis): Vaginal pH >4.5 \u2714 (NOT <4.5 \u2014 option b is wrong). POSITIVE WHIFF TEST (10% KOH\/positive potassium hydroxide test) \u2714 \u2014 adding 10% KOH to vaginal discharge releases amines (fishy\/amine odour) from Gardnerella and anaerobes; POSITIVE KOH test = whiff test positive = a BEDSIDE diagnostic criterion. Clue cells >20% on wet mount. Homogeneous thin discharge. NAAT (nucleic acid amplification): detects Gardnerella\/BV-associated bacteria but is NOT a bedside test. RBCs: not a BV criterion. Vaginal pH <4.5 = NORMAL\/candidiasis (NOT BV). The bedside criterion = positive 10% KOH (whiff) test. Answer: Positive 10% potassium hydroxide test.'},\n{id:71,stem:'Which of the following statements about hysterosalpingography, as an operative procedure, are correct?\\nI. Tubal patency assessment following tuboplasty operation\\nII. Diagnosis of uterine synechiae\\nIII. Detection of IUD\\nIV. Diagnosis of subserosal fibroid\\nSelect the answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Hysterosalpingography (HSG) \u2014 indications and uses: TUBAL PATENCY after tuboplasty \u2714 \u2014 HSG assesses tubal patency following reconstructive tubal surgery; contrast should fill and spill freely. UTERINE SYNECHIAE (Asherman\\'s syndrome) \u2714 \u2014 intrauterine filling defects on HSG indicate adhesions\/synechiae; irregular outline of uterine cavity. DETECTION OF IUD \u2714 \u2014 HSG can localise a \"lost\" or malpositioned IUD; though ultrasound and X-ray are more common, HSG can demonstrate the IUD position relative to the uterine cavity. SUBSEROSAL FIBROID \u2717 \u2014 HSG is excellent for SUBMUCOSAL fibroids (distort the uterine cavity \u2192 filling defect) and intracavitary polyps; however SUBSEROSAL fibroids are OUTSIDE the uterine cavity and do NOT distort the cavity outline \u2192 NOT diagnosed by HSG (USS\/MRI for subserosal fibroids). Correct: I, II, III. Answer: I, II and III.'},\n{id:72,stem:'Which of the following are indications of endometrial sampling?\\nI. Endometrial tuberculosis\\nII. Endometrial polyp\\nIII. Postmenopausal bleeding\\nIV. Abnormal uterine bleeding\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Endometrial sampling (Pipelle\/D&C\/hysteroscopy with biopsy) indications: ENDOMETRIAL TUBERCULOSIS \u2714 \u2014 endometrial biopsy is used to diagnose TB endometritis; histology shows granulomas; TB culture from sample; menstrual blood culture for AFB. POSTMENOPAUSAL BLEEDING \u2714 \u2014 MANDATORY indication; must exclude endometrial carcinoma\/hyperplasia; any postmenopausal bleeding requires endometrial sampling. ABNORMAL UTERINE BLEEDING \u2714 \u2014 particularly in women >40 years or those with risk factors; to exclude endometrial pathology. ENDOMETRIAL POLYP \u2717 \u2014 polyps are diagnosed by ultrasound (saline infusion sonohysterography) or hysteroscopy; endometrial SAMPLING alone (Pipelle) may MISS a polyp (small surface area sampled); the treatment of a polyp is HYSTEROSCOPIC POLYPECTOMY, not mere sampling. While biopsy is taken at the time of polypectomy, polyp diagnosis itself is not an indication FOR sampling per se. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:73,stem:'A 30-year-old P\u2083L\u2083 female presents in Gynaecology emergency with acute abdominal pain and vaginal bleeding of short duration (1 hour). She gives history of tubal ligation after birth of third child. On examination, right adnexal tenderness was found and os was closed. What is the probable diagnosis?',correct:'Ectopic pregnancy',options:['Ectopic pregnancy','Pelvic inflammatory disease','Appendicitis','Complete abortion'],exp:'ECTOPIC PREGNANCY despite history of tubal ligation: KEY CLUES: P3L3 with TUBAL LIGATION \u2014 sterilisation failure (especially if performed via ligation, clips, or rings); failure rate ~0.5\u20131 per 100 woman-years; when tubal ligation fails, the resulting pregnancy is MORE LIKELY TO BE ECTOPIC (approximately 50% of failures). Closed OS \u2714 \u2014 rules out spontaneous abortion (open os). Right adnexal tenderness \u2714 \u2014 suggestive of right tube ectopic. Acute abdominal pain + vaginal bleeding + closed os + adnexal tenderness = ECTOPIC PREGNANCY. PID: no closed os restriction; bilateral tenderness; fever; discharge. Appendicitis: no vaginal bleeding; right iliac fossa pain; no adnexal mass. Complete abortion: open os; all POC expelled. Answer: Ectopic pregnancy.'},\n{id:74,stem:'Which of the following statements are correct regarding audit in Obstetrics and Gynaecology?\\nI. It can replace the out of date clinical practices with better ones\\nII. It is an efficient educational tool\\nIII. It should be based on scientific evidences with facts and figures\\nIV. It is not labour-intensive\\nSelect the answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Clinical audit in Obstetrics and Gynaecology: Statement I \u2714 \u2014 Clinical audit is the AUDIT CYCLE: measures current practice against standards \u2192 identifies gaps \u2192 implements changes \u2192 RE-AUDIT; this process REPLACES outdated practices with evidence-based better ones. Statement II \u2714 \u2014 EDUCATIONAL TOOL: audit teaches trainees about best practices, clinical standards, quality improvement methodology; raises awareness of where care falls short. Statement III \u2714 \u2014 Audit should be based on EVIDENCE-BASED STANDARDS (clinical guidelines, NICE\/RCOG protocols) with objective data \u2014 facts and figures; not opinion-based. Statement IV \u2717 \u2014 Clinical audit IS labour-intensive: it requires data collection, analysis, implementation of changes, and re-audit; it demands significant time and resources from clinical teams. Correct: I, II, III. Answer: I, II and III.'},\n{id:75,stem:'Which of the following are poor prognostic factors in endometrial adenocarcinoma?\\nI. Estrogen and progesterone receptor positivity\\nII. HER-2\/neu gene expression\\nIII. Histologic types papillary serous or clear cell carcinoma\\nIV. Aneuploid tumours\\nSelect the correct answer:',correct:'II, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Endometrial carcinoma \u2014 poor prognostic factors: Statement I \u2717 \u2014 ER\/PR POSITIVITY is a GOOD prognostic factor; receptor-positive tumours are well-differentiated (Type I), respond to progestin therapy, and have better outcomes. Statement II \u2714 \u2014 HER-2\/NEU OVEREXPRESSION: poor prognosis; associated with serous carcinoma, high-grade tumours, advanced stage; HER-2 positive \u2192 aggressive behaviour. Statement III \u2714 \u2014 PAPILLARY SEROUS and CLEAR CELL carcinoma = TYPE II endometrial cancers; high grade, aggressive; deep myometrial invasion; early metastasis; much worse prognosis than endometrioid carcinoma. Statement IV \u2714 \u2014 ANEUPLOIDY (abnormal DNA content) = poor prognosis; aneuploid tumours are more aggressive, higher grade, more likely to recur. Correct: II, III, IV. Answer: II, III and IV.'},\n{id:76,stem:'For which of the following conditions, surgery is indicated in a case of Fibroid Uterus?\\nI. Symptomatic and failed medical management\\nII. Size > 12 weeks\\nIII. Pedunculated fibroid\\nSelect the correct answer:',correct:'I and II only',options:['I, II and III','I and II only','II and III only','I and III only'],exp:'Surgical indications for uterine fibroids: Statement I \u2714 \u2014 SYMPTOMATIC FIBROIDS (AUB, pressure symptoms, infertility, recurrent miscarriage) that have FAILED MEDICAL MANAGEMENT \u2014 the primary surgical indication. Statement II \u2714 \u2014 SIZE >12 WEEKS uterine size: fibroids causing significant uterine enlargement (>12 weeks\/300g) warrant surgery, especially if symptomatic; also for concern about masking ovarian pathology and obstruction. Statement III \u2717 \u2014 PEDUNCULATED FIBROID per se is NOT an independent indication for surgery; pedunculated subserosal fibroids are often asymptomatic; pedunculated submucosal (intracavitary) fibroids causing AUB would fall under \"symptomatic\" (Statement I). A pedunculated fibroid without symptoms does not require surgery. Correct: I and II. Answer: I and II only.'},\n{id:77,stem:'Which of the following is measured without any straining while examination under POP-Q system?',correct:'TVL',options:['TVL','Pb','GH','Point D'],exp:'POP-Q (Pelvic Organ Prolapse Quantification) system measurements: TVL (Total Vaginal Length) \u2714 \u2014 measured WITHOUT straining\/Valsalva; represents the total length of the vagina from the hymen to the posterior vaginal fornix (or vaginal vault in post-hysterectomy); recorded at REST. All OTHER POP-Q measurements (Aa, Ba, C, D, Ap, Bp, GH, Pb) are measured WITH MAXIMUM VALSALVA\/STRAINING: GH (Genital Hiatus): measured at maximum Valsalva. Pb (Perineal Body): measured at maximum Valsalva. Point D (posterior vaginal fornix): measured with Valsalva. Points Aa, Ba, C, Ap, Bp: all with Valsalva. TVL is the ONLY POP-Q measurement made at rest (without straining). Answer: TVL.'},\n{id:78,stem:'Which of the following are criteria for opting Le Fort\\'s operation for surgical correction of pelvic organ prolapse?\\nI. Procidentia in old age\\nII. Unfit for long duration surgery\\nIIII. Associated uterine pathology\\nIV. Coital function no longer required\\nSelect the correct answer:',correct:'I, II and IV',options:['I, III and IV','I and II only','II, III and IV','I, II and IV'],exp:'Le Fort\\'s colpocleisis operation \u2014 criteria\/indications: It is an OBLITERATIVE procedure (partial colpocleisis): suitable for elderly women with PROCIDENTIA who no longer require vaginal coitus. PROCIDENTIA IN OLD AGE \u2714 \u2014 ideal candidates; elderly frail patients with complete uterovaginal prolapse. UNFIT FOR LONG DURATION SURGERY \u2714 \u2014 Le Fort\\'s is a relatively quick, simple procedure under regional anaesthesia; suitable for patients who cannot tolerate prolonged surgery. COITAL FUNCTION NO LONGER REQUIRED \u2714 \u2014 ABSOLUTE requirement; the vaginal canal is largely obliterated \u2192 sexual intercourse is no longer possible after the procedure; patient and partner must consent to this. ASSOCIATED UTERINE PATHOLOGY \u2717 \u2014 if there is suspected\/confirmed uterine pathology (fibroids, malignancy), Le Fort\\'s is CONTRAINDICATED; it leaves the uterus in situ and creates a vaginal canal for drainage monitoring; any pathology cannot be managed and could be masked. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:79,stem:'Opening of Bartholin\\'s duct is in the:',correct:'vestibule outside the hymen at the junction of the anterior 2\/3rd and posterior 1\/3rd in the groove between the hymen and labium minus',options:['vestibule outside the hymen at the junction of the anterior 2\/3rd and posterior 1\/3rd in the groove between the hymen and labium minus','groove between labia majora and labia minora','superficial perineal pouch at the junction of anterior 1\/3rd and post 1\/3rd','periurethral region in anterior 1\/3rd of labia minora'],exp:'Bartholin\\'s gland (greater vestibular gland) anatomy: GLAND: lies in the posterior part of the labium majus, superficial to the perineal membrane (urogenital diaphragm). DUCT: approximately 2 cm long; opens into the VESTIBULE (outside the hymen) at the JUNCTION OF THE ANTERIOR 2\/3 AND POSTERIOR 1\/3 of the groove between the hymen and labium minus \u2714 (at approximately 4 o\\'clock and 8 o\\'clock positions). This is a high-yield anatomical fact: opening is in the groove between hymen and labium minus, at the junction of anterior 2\/3 and posterior 1\/3. Answer: Vestibule outside the hymen at the junction of the anterior 2\/3rd and posterior 1\/3rd in the groove between the hymen and labium minus.'},\n{id:80,stem:'Which of the following are Amsel\\'s diagnostic criteria?\\nI. Vaginal pH > 4.5\\nII. Positive Whiff test\\nIII. Presence of clue cells > 20%\\nIV. Positive bacterial vaginal culture\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Amsel\\'s criteria for BACTERIAL VAGINOSIS (3 of 4 required for diagnosis): VAGINAL pH >4.5 \u2714 (Statement I) \u2014 loss of Lactobacillus acid production \u2192 alkaline pH. POSITIVE WHIFF TEST \u2714 (Statement II) \u2014 fishy amine odour released when 10% KOH added to discharge (positive potassium hydroxide test). CLUE CELLS >20% \u2714 (Statement III) \u2014 epithelial cells studded with Gardnerella\/anaerobes; stippled appearance on wet mount; >20% clue cells of all epithelial cells. HOMOGENEOUS THIN GREY\/WHITE DISCHARGE (4th criterion \u2014 not listed here). BACTERIAL VAGINAL CULTURE \u2717 (Statement IV) \u2014 bacterial culture is NOT one of Amsel\\'s criteria; Gardnerella vaginalis cultures are not specific (it is part of normal flora); culture is not used clinically for BV diagnosis. Correct Amsel\\'s criteria: I, II, III. 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Submitting in 10 Submit Now Combined Medical Services Examination 2025Paper II \u00b7 Part B Gynaecology & Obstetrics (Q41 \u2013 Q80) Questions 41 \u2013 80 +1 correct \u00b7 \u2212\u2153 wrong \u23f1 Start Timed Mode Submit Answers 0%score Your Result \u21ba Retry… <\/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-36844","post","type-post","status-publish","format-standard","hentry","category-cms","category-obg"],"yoast_head":"\n<title>CMS 2025 P2 Part-B - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/05\/16\/cms-2025-p2-part-b\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2025 P2 Part-B - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2025 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0.00 \/ 40 Time's Up! 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var(--teal);color:var(--teal);border-radius:8px;padding:10px 28px;font-family:'Playfair Display',serif;font-size:.95rem;font-weight:700;cursor:pointer;transition:background .2s,color .2s}\n#cms25p2b .rbtn:hover{background:var(--teal);color:var(--white)}\n@media(max-width:480px){#cms25p2b .hdr h1{font-size:1.15rem}#cms25p2b .qt{font-size:.88rem}#cms25p2b .ot{font-size:.84rem}}\n<\/style>\n<\/head>\n<body>\n<div id=\"cms25p2b\">\n<div class=\"sen\" id=\"cms25p2b-sen\"><\/div>\n<div class=\"sb\" id=\"cms25p2b-sb\">\n <div class=\"sb-row\">\n <div class=\"ti\" id=\"cms25p2b-ti\">\u23f1 <strong id=\"cms25p2b-td\">40:00<\/strong><\/div>\n <div class=\"sb-it\">\u2705 <strong id=\"cms25p2b-sc\">0<\/strong><\/div>\n <div class=\"sb-it\">\u274c <strong id=\"cms25p2b-sw\">0<\/strong><\/div>\n <div class=\"sb-it\">\u23f3 <strong id=\"cms25p2b-sr\">40<\/strong> left<\/div>\n <div class=\"sb-sep\"><\/div>\n <div class=\"sb-it\">Net <strong id=\"cms25p2b-sn\">0.00<\/strong> \/ <strong id=\"cms25p2b-sm\">40<\/strong><\/div>\n <\/div>\n <div class=\"sb-bar\"><div class=\"sb-fill\" id=\"cms25p2b-fill\"><\/div><\/div>\n<\/div>\n<div class=\"grace\" id=\"cms25p2b-grace\">\n <div class=\"gb\">\n <h3>Time's Up!<\/h3><p>Submitting in<\/p>\n <div class=\"gc\" id=\"cms25p2b-gc\">10<\/div>\n <button class=\"gnow\" id=\"cms25p2b-gnow\">Submit Now<\/button>\n <\/div>\n<\/div>\n<div class=\"hdr\">\n <h1>Combined Medical Services Examination 2025<br>Paper II \u00b7 Part B<\/h1>\n <p>Gynaecology & Obstetrics (Q41 \u2013 Q80)<\/p>\n <div class=\"meta\">\n <span class=\"bdg\">Questions 41 \u2013 80<\/span>\n <span class=\"bdg\">+1 correct \u00b7 \u2212\u2153 wrong<\/span>\n <button class=\"tbtn\" id=\"cms25p2b-tbtn\">\u23f1 Start Timed Mode<\/button>\n <\/div>\n<\/div>\n<div class=\"body\">\n <div id=\"cms25p2b-qs\"><\/div>\n <div class=\"sw\"><button class=\"btn\" id=\"cms25p2b-sub\">Submit Answers<\/button><\/div>\n <div class=\"sc\" id=\"cms25p2b-sc-box\">\n <div class=\"ring\" id=\"cms25p2b-ring\"><div class=\"ri\"><span class=\"rp\" id=\"cms25p2b-rp\">0%<\/span><span class=\"rs\">score<\/span><\/div><\/div>\n <h2>Your Result<\/h2>\n <div class=\"nl\" id=\"cms25p2b-nl\"><\/div>\n <div class=\"vd\" id=\"cms25p2b-vd\"><\/div>\n <div class=\"bands\">\n <span class=\"band bc\" id=\"cms25p2b-bc\"><\/span>\n <span class=\"band bw\" id=\"cms25p2b-bw\"><\/span>\n <span class=\"band bs\" id=\"cms25p2b-bs\"><\/span>\n <\/div>\n <button class=\"rbtn\" id=\"cms25p2b-retry\">\u21ba Retry Quiz<\/button>\n <\/div>\n<\/div>\n<\/div>\n<script>\n(function(){\n'use strict';\nvar NS='cms25p2b',TOTAL=40,MAX=40,TSECS=2400,GSECS=10;\nvar CU=100,WU=33;\nvar QS=[\n{id:41,stem:'Chadwick\\'s sign describes:',correct:'the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy',options:['the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy','softening of cervix at 6th week of pregnancy','the abdominal and vaginal fingers apposed below the body of the uterus during bimanual examination','regular and rhythmic uterine contraction which can be elicited during bimanual examination at 4-8 weeks of pregnancy'],exp:'Signs of pregnancy \u2014 identification: CHADWICK\\'S SIGN \u2714 \u2014 the dusky, violet\/bluish-purple discolouration of the VESTIBULE and anterior vaginal wall (and cervix) visible from about 6\u20138 weeks of pregnancy; caused by increased vascularity and venous congestion of pelvic organs. Other options: Goodell\\'s sign: softening of the cervix (from ~6th week). Hegar\\'s sign: softening of the isthmus of the uterus; abdominal and vaginal fingers can be almost apposed below the body of the uterus during bimanual examination (~6\u20138 weeks). Braxton Hicks: irregular, painless uterine contractions; Piskacek\\'s sign involves the asymmetric enlargement. Regular rhythmic contractions = true labour or Braxton Hicks. Answer: Dusky hue of vestibule and anterior vaginal wall at about 8th week.'},\n{id:42,stem:'Which of the following treatments are recommended for a pregnant woman suffering from sickle cell disease?\\nI. Folic acid 1 mg daily\\nII. Azathioprine\\nIII. Penicillin prophylaxis\\nIV. Thromboprophylaxis with low molecular weight heparin\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Sickle cell disease in pregnancy \u2014 management: FOLIC ACID 1 mg daily \u2714 \u2014 increased folate demand due to haemolysis and rapid cell turnover; essential to prevent megaloblastic anaemia; 5 mg daily may be preferred in some guidelines. AZATHIOPRINE \u2717 \u2014 immunosuppressant; NOT used in sickle cell disease management during pregnancy; has teratogenic potential. PENICILLIN PROPHYLAXIS \u2714 \u2014 sickle cell disease causes functional asplenia \u2192 susceptibility to encapsulated organisms; penicillin prophylaxis recommended throughout life including pregnancy. THROMBOPROPHYLAXIS WITH LMWH \u2714 \u2014 pregnancy + sickle cell disease = very high thrombotic risk; LMWH thromboprophylaxis recommended throughout pregnancy and 6 weeks postpartum. Also: hydroxyurea is stopped before\/during pregnancy; regular blood transfusions as needed. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:43,stem:'Which of the following are contraindications to External Cephalic Version (ECV) in breech?\\nI. Pregnancy less than 36 weeks\\nII. Multiple pregnancy\\nIII. Previous caesarean delivery\\nIV. Rhesus isoimmunisation\\nSelect the correct answer:',correct:'I, II and IV',options:['I, III and IV','II, III and IV','I, II and IV','I, II and III'],exp:'ECV contraindications: Statement I \u2714 \u2014 Pregnancy <36 weeks: ECV is performed at \u226536 weeks (term); before this gestation the fetus may spontaneously turn and there is greater risk of preterm labour. Statement II \u2714 \u2014 MULTIPLE PREGNANCY: absolute contraindication; manipulating one twin risks the co-twin, cord entanglement, and premature labour. Statement III \u2717 \u2014 PREVIOUS CAESAREAN SECTION: this is a RELATIVE contraindication in some guidelines (risk of uterine scar rupture during ECV); but most current guidelines (RCOG) do not list it as an absolute contraindication; ECV can be offered with informed consent. Statement IV \u2714 \u2014 RHESUS ISOIMMUNISATION: ECV causes fetomaternal haemorrhage \u2192 in Rh-negative sensitised mothers, additional immunisation worsens the existing antibody titre; contraindicated. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:44,stem:'Which of the following haematological findings are seen in pregnant women with thalassaemia trait?',correct:'Raised HbA\u2082 and low MCV',options:['Raised HbA\u2082 and low MCV','Low MCHC','Low serum total iron binding capacity','Low HbA\u2082 and raised MCV'],exp:'Beta-thalassaemia trait (carrier state) \u2014 haematological features: RAISED HbA\u2082 \u2714 \u2014 HbA\u2082 (\u03b1\u2082\u03b4\u2082) is elevated (>3.5%, usually 4\u20137%); this is the DIAGNOSTIC HALLMARK of beta-thalassaemia trait; elevated because beta chains are reduced so delta chains compensate. LOW MCV (microcytosis) \u2714 \u2014 small red cells; hypochromic; due to reduced beta globin chain synthesis \u2192 reduced Hb per cell. Also: low MCH, mild anaemia (Hb 10\u201312 g\/dL), target cells, normal\/low serum ferritin (unlike iron deficiency). MCHC: may be low or normal. TIBC: normal (not reduced \u2014 that would suggest iron overload). MCV is LOW not raised (raised MCV suggests B12\/folate deficiency or macrocytosis). Answer: Raised HbA\u2082 and low MCV.'},\n{id:45,stem:'The best drug for maintenance therapy of Systemic Lupus Erythematosus (SLE) during pregnancy is:',correct:'Hydroxychloroquine',options:['Hydroxychloroquine','Sulfasalazine','Tacrolimus','Progestins'],exp:'SLE in pregnancy \u2014 maintenance therapy: HYDROXYCHLOROQUINE (HCQ) \u2714 \u2014 the cornerstone of SLE maintenance during pregnancy. Reasons: (1) Reduces lupus flares during pregnancy; (2) Reduces risk of neonatal lupus and congenital heart block; (3) Safe in pregnancy (no teratogenicity established); (4) Reduces risk of pre-eclampsia and thrombosis in antiphospholipid antibody-positive patients. Continuing HCQ throughout pregnancy is strongly recommended by ACR\/EULAR. Sulfasalazine: used in SLE\/rheumatoid arthritis but not the first-line maintenance; less evidence. Tacrolimus: calcineurin inhibitor; used in renal SLE\/lupus nephritis but not standard maintenance. Progestins: no role in SLE maintenance. Answer: Hydroxychloroquine.'},\n{id:46,stem:'Which of the following maternal complications can be seen in hyperemesis gravidarum?\\nI. Wernicke\\'s encephalopathy\\nII. Hepatic failure\\nIII. Hypoprothrombinemia\\nIV. Convulsions\\nSelect the correct answer:',correct:'I, II and IV only',options:['I, II, III and IV','I, III and IV only','I, II and IV only','II and III only'],exp:'Hyperemesis gravidarum (HG) \u2014 maternal complications: WERNICKE\\'S ENCEPHALOPATHY \u2714 \u2014 thiamine (B1) deficiency from prolonged vomiting and poor intake \u2192 Wernicke\\'s (ophthalmoplegia, ataxia, confusion); thiamine must be supplemented before\/with IV dextrose. HEPATIC FAILURE \u2714 \u2014 severe HG can cause transient LFT derangement and in extreme cases hepatic dysfunction\/failure; liver involvement occurs in ~50% of severe HG. CONVULSIONS \u2714 \u2014 from severe electrolyte disturbances (hyponatraemia \u2192 seizures) and Wernicke\\'s encephalopathy. HYPOPROTHROMBINEMIA \u2717 \u2014 while malnutrition can affect coagulation factors long-term, hypoprothrombinemia is NOT a recognised\/typical complication of HG specifically. Official answer: I, II and IV. Answer: I, II and IV only.'},\n{id:47,stem:'The commonest ovarian tumour seen during pregnancy is:',correct:'Benign cystic teratoma',options:['Benign cystic teratoma','Mucinous cystadenoma','Endometrioma','Adenocarcinoma ovary'],exp:'Ovarian tumours in pregnancy: BENIGN CYSTIC TERATOMA (dermoid cyst) \u2714 \u2014 the MOST COMMON ovarian tumour found during pregnancy; accounts for ~35\u201340% of all ovarian masses in pregnancy. Dermoid cysts are germ cell tumours containing ectodermal elements (skin, hair, teeth, sebaceous material). They are typically unilateral, mobile, and identified incidentally on routine obstetric ultrasound. Risk: torsion (most common complication in pregnancy). Also common: mucinous cystadenoma (second most common), serous cystadenoma. Endometrioma: can occur during pregnancy but less common. Adenocarcinoma: rare (~1 in 18,000 pregnancies). Answer: Benign cystic teratoma.'},\n{id:48,stem:'Which of the following statements are correct regarding shoulder dystocia?\\nI. It can be predicted during early labour\\nII. Anencephaly is a risk factor\\nIII. Turtle neck sign is present\\nIV. Episiotomy should always be given\\nSelect the answer:',correct:'II and III only',options:['I, II and III','I, II and IV','II and III only','I, III and IV'],exp:'Shoulder dystocia: Statement I \u2717 \u2014 Shoulder dystocia CANNOT be reliably predicted; while risk factors exist (macrosomia, GDM, previous shoulder dystocia, prolonged second stage), the majority of cases occur without identifiable risk factors; it is largely unpredictable. Statement II \u2714 \u2014 ANENCEPHALY is a risk factor; the absence of the skull means the head delivers easily but the shoulders are proportionally wider \u2192 relative shoulder dystocia; also any condition with macrosomia or short fetal trunk. Statement III \u2714 \u2014 TURTLE NECK SIGN (retraction sign): after delivery of the head, it retracts back against the perineum (like a turtle retreating into its shell); pathognomonic of shoulder dystocia. Statement IV \u2717 \u2014 Episiotomy does NOT relieve bony shoulder dystocia; shoulders are impacted at the bony pelvic inlet; episiotomy creates more soft tissue room (for manoeuvres like Woods screw) but is NOT always required and is NOT the primary treatment. Correct: II and III. Answer: II and III only.'},\n{id:49,stem:'A primigravida at 38 weeks pregnancy was put on oxytocin drip in view of slow labour at the rate of 30 mIU\/min by the newly appointed registrar. She complains of confusion and starts throwing fits. What electrolyte imbalance is expected to have happened in this case?',correct:'Hyponatremia',options:['Hypokalemia','Hyponatremia','Hypocalcemia','Hypernatremia'],exp:'OXYTOCIN at HIGH DOSES (30 mIU\/min is excessive \u2014 standard maximum is 20\u201340 mIU\/min but with careful monitoring) \u2192 ANTIDIURETIC EFFECT: oxytocin is structurally similar to ADH (vasopressin); at high doses it acts as an antidiuretic \u2192 water retention \u2192 dilutional HYPONATRAEMIA. Features of water intoxication\/hyponatraemia: confusion, headache, CONVULSIONS (fits) \u2714, coma, pulmonary oedema. Risk factors: large volumes of hypotonic IV fluids + high-dose oxytocin infusion. Prevention: use isotonic saline (not 5% dextrose) as oxytocin carrier; limit fluid intake; monitor urine output and sodium. Answer: Hyponatremia.'},\n{id:50,stem:'Which of the following factors favour posterior position of the vertex?\\nI. Anthropoid pelvis\\nII. Low inclination pelvis\\nIII. Attachment of placenta on the anterior wall\\nIV. Primary brachycephaly\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Factors favouring OCCIPITO-POSTERIOR (OP) position: ANTHROPOID PELVIS \u2714 \u2014 oval AP diameter > transverse; the long AP diameter accommodates the head in the AP diameter with occiput posterior; most OP positions occur in anthropoid pelvis. ANTERIOR PLACENTA \u2714 \u2014 placenta on anterior uterine wall takes up space anteriorly \u2192 fetal back (and occiput) is pushed posteriorly; consistently associated with OP position. PRIMARY BRACHYCEPHALY \u2714 \u2014 a broad, short head shape (brachycephalic skull) tends to enter in the OP position. LOW INCLINATION PELVIS \u2717 \u2014 a pelvis with low inclination (flat\/platypelloid type) favours a TRANSVERSE engagement; the platypelloid pelvis with wide transverse diameter favours OT, not OP position. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:51,stem:'Which of the following factors are associated with cord prolapse during labour?\\nI. Malpresentations\\nII. Contracted pelvis\\nIII. Stabilising induction\\nIV. Prematurity\\nSelect the correct answer:',correct:'I, II, III and IV',options:['I, II, III and IV','I, II and IV only','I, II and III only','III and IV only'],exp:'Umbilical cord prolapse \u2014 risk factors: MALPRESENTATIONS \u2714 \u2014 breech, transverse lie, oblique lie, footling breech \u2192 the presenting part does not fit snugly into the pelvis \u2192 space for cord to prolapse. CONTRACTED PELVIS \u2714 \u2014 a contracted\/flat pelvis \u2192 poor engagement \u2192 space between presenting part and pelvic brim \u2192 cord can slip through. STABILISING INDUCTION (induction when head is high\/unengaged) \u2714 \u2014 performing AROM (amniotomy) when the head is not engaged \u2192 sudden rush of liquor carries the cord down \u2192 cord prolapse; this is a recognised iatrogenic cause. PREMATURITY \u2714 \u2014 preterm fetuses are small \u2192 poor fit of presenting part to the pelvis \u2192 increased risk of cord prolapse. All four are established risk factors. Answer: I, II, III and IV.'},\n{id:52,stem:'Detection of magnesium toxicity in a patient receiving magnesium sulphate is noticed by which of the following?\\nI. Loss of tendon reflexes\\nII. Increased respiratory rate\\nIII. Chest pain, heart block\\nIV. Cardiac arrest\\nSelect the correct answer:',correct:'I, III and IV',options:['I, III and IV','II and IV only','I and III only','III and IV only'],exp:'Magnesium sulphate toxicity \u2014 sequence with increasing serum levels: 4\u20137 mEq\/L (therapeutic): anticonvulsant effect, mild nausea. 7\u201310 mEq\/L: LOSS OF PATELLAR TENDON REFLEXES \u2714 (Statement I \u2014 first clinical sign of toxicity; MONITOR reflexes hourly). 10\u201313 mEq\/L: respiratory depression (DECREASED not increased respiratory rate \u2717 \u2014 Statement II says INCREASED which is WRONG). 13\u201315 mEq\/L: RESPIRATORY PARALYSIS. 15+ mEq\/L: CARDIAC CONDUCTION DEFECTS, HEART BLOCK \u2714 (Statement III). CARDIAC ARREST \u2714 (Statement IV \u2014 at very high levels). Statement II \u2717 \u2014 magnesium toxicity causes respiratory DEPRESSION (slowed rate), NOT increased respiratory rate. Correct: I, III, IV. Antidote: calcium gluconate 1g IV. Answer: I, III and IV.'},\n{id:53,stem:'Which one of the following is correct regarding postpartum psychosis?',correct:'Recurrence rate in subsequent pregnancy is 60-70%.',options:['There is often no family history of psychosis.','Its onset is usually within 4 days of delivery.','Recurrence rate in subsequent pregnancy is 60-70%.','Electro convulsive therapy is the first treatment of choice.'],exp:'Postpartum psychosis (puerperal psychosis): Option a \u2717 \u2014 there IS often a POSITIVE family history of psychosis (especially bipolar disorder); genetic predisposition is strong; 50% have a personal or family history of bipolar\/schizophrenia. Option b \u2717 \u2014 onset is typically within 2 WEEKS, most commonly within the first WEEK (days 3\u201314); \"within 4 days\" is too specific\/restrictive. Option c \u2714 \u2014 RECURRENCE RATE in subsequent pregnancies is HIGH: 60\u201370% (some sources say 50\u201380%); women with a history of puerperal psychosis have very high risk of recurrence with subsequent pregnancies and must be counselled and monitored. Option d \u2717 \u2014 FIRST treatment of choice is antipsychotic medication (haloperidol, olanzapine) \u00b1 mood stabiliser; ECT is reserved for SEVERE, treatment-resistant cases or when rapid response is critical. Answer: Recurrence rate in subsequent pregnancy is 60-70%.'},\n{id:54,stem:'Which of the following are correct in the treatment of cracked nipple?\\nI. Correct attachment (Latch on) will provide immediate relief from pain and rapid healing\\nII. If pain, mother should use breast pump and the infant is fed with the expressed milk\\nIII. Miconazole lotion is applied over the nipple as well as in the baby\\'s mouth if there is oral thrush\\nSelect the answer:',correct:'I, II and III',options:['I and II only','II and III only','I and III only','I, II and III'],exp:'Cracked nipple management: Statement I \u2714 \u2014 CORRECT ATTACHMENT\/LATCH is the PRIMARY treatment; most cracked nipples result from poor latching technique; correct positioning \u2192 baby takes a large amount of areola \u2192 no nipple trauma \u2192 pain relief and healing. Statement II \u2714 \u2014 If pain is severe and breastfeeding too painful: temporarily use BREAST PUMP to express milk \u2192 feed expressed breast milk by cup\/spoon \u2192 maintains milk supply while nipple heals. Statement III \u2714 \u2014 If ORAL THRUSH (Candida) is present in the baby\\'s mouth, it can infect the mother\\'s nipple (Candidal mastitis\/nipple infection); treatment: MICONAZOLE GEL\/LOTION applied to BOTH the nipple AND inside the baby\\'s mouth simultaneously (to prevent ping-pong infection). All three statements are correct. Answer: I, II and III.'},\n{id:55,stem:'Which of the following are correct regarding puerperal blues?\\nI. Its incidence is around 50%\\nII. There is no specific metabolic or endocrine derangement\\nIIII. Treatment is reassurance and psychological support\\nSelect the answer:',correct:'I, II and III',options:['I and II only','II and III only','I and III only','I, II and III'],exp:'Puerperal (baby) blues: INCIDENCE \u2714 \u2014 affects approximately 50\u201380% of all mothers (some sources say 30\u201375%; \"around 50%\" is widely quoted and considered correct). AETIOLOGY \u2714 \u2014 no SPECIFIC metabolic or endocrine cause identified; despite occurring during the rapid hormonal withdrawal (oestrogen\/progesterone\/prolactin changes), no consistent specific endocrine derangement has been demonstrated; multifactorial (fatigue, emotional adjustment, hormonal changes). TREATMENT \u2714 \u2014 REASSURANCE and PSYCHOLOGICAL\/EMOTIONAL SUPPORT are the mainstay; puerperal blues is self-limiting (resolves within 10\u201314 days); no specific pharmacotherapy required; if persists beyond 2 weeks \u2192 screen for postnatal depression. All three correct. Answer: I, II and III.'},\n{id:56,stem:'The Matthews Duncan process has been described for:',correct:'marginal separation of placenta in normal labour',options:['marginal separation of placenta in normal labour','central separation of placenta in normal labour','controlled contraction in active management of third stage of labour','reposition of acute inversion of uterus following vaginal delivery'],exp:'Placental separation mechanisms: SCHULTZE METHOD (central separation): placenta separates from the centre first \u2192 fetal surface delivers first (shiny, smooth side); blood trapped behind placenta. MATTHEWS DUNCAN METHOD \u2714 \u2014 MARGINAL SEPARATION: the placenta separates from the lower edge\/margin first \u2192 slides down and emerges sideways (like a button being pushed through a buttonhole); maternal (raw) surface presents first; blood trickles around the edge and drips out during separation. More common with lower-segment placentas. Associated with more blood loss than Schultze. Answer: Marginal separation of placenta in normal labour.'},\n{id:57,stem:'A PILI lady after 4 hours of delivery is suffering from persistent, severe pain in the perineal region, rectal tenesmus, bearing down feeling and retention of urine. The probable diagnosis is:',correct:'Supralevator hematoma',options:['Cervical tear','Vulval hematoma','Supralevator hematoma','Complete perineal tear'],exp:'POST-PARTUM HAEMATOMA \u2014 differential by site: VULVAL HAEMATOMA: visible swelling in labia\/vulva; severe perineal pain; variable urinary retention; visible\/palpable. PARAVAGINAL\/INFRALEVATOR: vaginal pain, swelling visible on examination. SUPRALEVATOR HAEMATOMA \u2714 \u2014 above the levator ani; blood tracks into the broad ligament\/retroperitoneal space; features: SEVERE PERINEAL PAIN + RECTAL TENESMUS (pressure on rectum) + BEARING DOWN FEELING + URINARY RETENTION (pressure on bladder); NO visible swelling externally; insidious; can be life-threatening. Cervical tear: postpartum haemorrhage, bright red bleeding; no haematoma. Complete perineal tear: visible tear through sphincter\/rectum; rectal examination reveals the tear. The clinical picture of deep pressure symptoms with NO external swelling = supralevator haematoma. Answer: Supralevator hematoma.'},\n{id:58,stem:'According to WHO Intrapartum Care Guidelines 2018, which one of the following is correct about duration of first stage of labour?',correct:'Duration of latent phase of primigravida has not been established',options:['Duration of latent phase of primigravida has not been established','Duration of active stage of multigravida should not exceed 6 hours','Duration of active stage of primigravida should not exceed 8 hours','Duration of active stage of primigravida should not exceed 18 hours'],exp:'WHO Intrapartum Care Guidelines 2018 \u2014 first stage of labour: LATENT PHASE: WHO 2018 states that the DURATION OF THE LATENT PHASE HAS NOT BEEN ESTABLISHED \u2714 \u2014 the latent phase length is highly variable and cannot be reliably defined; women should not be admitted routinely in the latent phase. ACTIVE PHASE (from 5 cm dilatation per WHO 2018): the active phase is defined as starting from 5 cm (not the older 3\u20134 cm definition). Duration: active phase in primigravida should progress at \u22650.5\u20131 cm\/hour; no fixed maximum duration is specified in the 2018 guidelines based on time alone. \"Should not exceed 8 hours\" (option c) is an older guideline figure. \"Not exceed 6 hours\" for multigravida: not specifically stated. Answer: Duration of latent phase of primigravida has not been established.'},\n{id:59,stem:'According to WHO Intrapartum Care Guidelines 2018, which of the following are correct about birthing position?\\nI. For a woman without epidural analgesia, adoption of birthing position is individual woman\\'s choice\\nII. For a woman without epidural analgesia, upright birthing position may be adopted\\nIII. For a woman with epidural analgesia, lithotomy and supine position only are recommended\\nSelect the answer:',correct:'I and II only',options:['I and II only','II and III only','I and III only','I, II and III'],exp:'WHO Intrapartum Care Guidelines 2018 \u2014 birthing positions: Statement I \u2714 \u2014 For women WITHOUT epidural analgesia: WOMAN\\'S OWN CHOICE of birthing position is recommended; no position should be imposed. Statement II \u2714 \u2014 UPRIGHT position (sitting, squatting, kneeling, standing) may be adopted; WHO encourages upright positions which have benefits (shorter second stage, reduced episiotomy, fewer assisted deliveries). Statement III \u2717 \u2014 FALSE. For women WITH epidural analgesia: WHO does NOT recommend ONLY lithotomy and supine; lateral (left lateral) position is also acceptable and preferred over supine; supine\/lithotomy is NOT exclusively recommended. \"Only lithotomy and supine\" is an overly restrictive statement not aligned with WHO 2018 recommendations. Correct: I and II. Answer: I and II only.'},\n{id:60,stem:'Twin pregnancy should have ultrasound at 10-13 weeks to confirm which of the following?\\nI. Number of foetus\\nII. Viability of foetus\\nIII. Chorionicity of twins\\nIV. Malformation in either foetus\\nSelect the correct answer:',correct:'I, II and III only',options:['I, II and III only','I and III only','II and IV only','I, II, III and IV'],exp:'First trimester ultrasound (10\u201313+6 weeks) in twin pregnancy: NUMBER OF FETUSES \u2714 \u2014 confirm the exact number (dichorionic-diamniotic, monochorionic-diamniotic, monoamniotic). VIABILITY \u2714 \u2014 confirm cardiac activity in both; identify vanishing twin. CHORIONICITY AND AMNIONICITY \u2714 \u2014 the MOST IMPORTANT determination; assessed at 10\u201314 weeks by: twin peak (lambda) sign = dichorionic; T-sign = monochorionic; number of placental masses; fetal sex (different sex = dichorionic). Chorionicity determines prognosis and surveillance intensity. MALFORMATION \u2717 \u2014 detailed structural anomaly survey is NOT reliably performed at 10\u201313 weeks (too early for most structural anomalies); the anomaly scan is at 18\u201322 weeks. NT measurement is done at this time but full morphology scan is later. Correct: I, II, III. Answer: I, II and III only.'},\n{id:61,stem:'Which of the following are neonatal complications of maternal diabetes during pregnancy?\\nI. Hyperbilirubinaemia\\nII. Hypercalcaemia\\nIII. Cardiomyopathy\\nIV. Hypoglycaemia\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Neonatal complications of diabetic pregnancy (IDM \u2014 infant of diabetic mother): HYPERBILIRUBINAEMIA \u2714 \u2014 polycythaemia (from erythropoietin stimulation by hypoxia) \u2192 increased RBC breakdown \u2192 jaundice. CARDIOMYOPATHY \u2714 \u2014 hypertrophic obstructive cardiomyopathy (septal hypertrophy) in ~30\u201340% of IDMs; usually resolves; can cause heart failure. HYPOGLYCAEMIA \u2714 \u2014 most common and most dangerous: fetal hyperinsulinaemia (from maternal hyperglycaemia) \u2192 after birth, maternal glucose supply stops but hyperinsulinaemia persists \u2192 neonatal hypoglycaemia; occurs within 1\u20132 hours of birth. HYPERCALCAEMIA \u2717 \u2014 IDMs develop HYPOCALCAEMIA (not hypercalcaemia); decreased PTH, hypomagnesaemia \u2192 neonatal hypocalcaemia \u2192 jitteriness, seizures. Also: macrosomia, respiratory distress syndrome (delayed lung maturation), polycythaemia. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:62,stem:'Which of the following are the predictive factors for Fetal Growth Restriction (FGR)?\\nI. Low level of maternal 1st trimester Beta hCG\\nII. Abnormal uterine artery Doppler at 20-24 weeks of pregnancy\\nIII. Fetal echogenic bowel on ultrasound\\nIV. Maternal medical disorder\\nSelect the correct answer:',correct:'II, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Predictive factors for FGR: Statement I \u2717 \u2014 LOW first trimester beta-hCG is NOT a recognised predictive factor for FGR; LOW PAPP-A (pregnancy-associated plasma protein A) IS a predictor of FGR\/placental dysfunction in first trimester screening. Statement II \u2714 \u2014 ABNORMAL UTERINE ARTERY DOPPLER at 20\u201324 weeks (increased resistance index, bilateral notching) is one of the best predictors of placental insufficiency \u2192 FGR and pre-eclampsia. Statement III \u2714 \u2014 FETAL ECHOGENIC BOWEL on ultrasound is associated with FGR (also associated with cystic fibrosis, chromosomal anomalies, CMV, Down syndrome). Statement IV \u2714 \u2014 MATERNAL MEDICAL DISORDERS: hypertension, diabetes, renal disease, autoimmune conditions (APS, SLE), thrombophilias \u2192 impaired placentation \u2192 FGR. Correct: II, III, IV. Answer: II, III and IV.'},\n{id:63,stem:'Which of the following is the primary surveillance tool in the Growth Restricted Fetus?',correct:'Umbilical artery doppler',options:['Uterine artery doppler','Umbilical venous pulsation','Middle cerebral artery doppler','Umbilical artery doppler'],exp:'FGR surveillance \u2014 primary tool: UMBILICAL ARTERY DOPPLER \u2714 \u2014 measures resistance in the placental circulation; the PRIMARY and FIRST-LINE surveillance tool for FGR. Abnormal findings: absent end-diastolic flow (AEDF) or reversed end-diastolic flow (REDF) \u2192 indicates severe placental insufficiency \u2192 guides timing of delivery. MCA Doppler: secondary tool; MCA-PSV used for fetal anaemia assessment; MCA PI used for \"brain-sparing\" (cerebro-umbilical ratio); second-line in FGR. Uterine artery Doppler: used for PREDICTION of FGR (at 20\u201324 weeks), not primary surveillance once FGR is established. Umbilical venous pulsation: a late, ominous sign of fetal cardiac compromise; used in conjunction with ductus venosus Doppler in late-stage FGR. Answer: Umbilical artery doppler.'},\n{id:64,stem:'Glands of Cloquet are:',correct:'lymphatic drainage of cervix',options:['lymphatic drainage of vulva','lymphatic drainage of cervix','lymphatic drainage of uterus','lubricating glands of vagina'],exp:'Glands\/Nodes of Cloquet (also called Node of Cloquet or Rosenm\u00fcller\\'s node): a group of deep inguinal lymph nodes situated in the femoral canal (between the femoral vein and the lacunar ligament). They receive LYMPHATIC DRAINAGE from: the CERVIX \u2714 (via parametrial and obturator routes to external iliac and then to Cloquet\\'s node), clitoris, glans penis, bladder trigone. Important: a positive Cloquet\\'s node in cervical carcinoma indicates pelvic lymph node metastasis \u2014 surgically significant. Note: Bartholin\\'s glands = lubricating; vulvar lymphatics \u2192 inguinal nodes. Answer: Lymphatic drainage of cervix.'},\n{id:65,stem:'Causes of AUB are subdivided by the acronym PALM-COEIN. What are the characteristics of PALM causes?\\nI. Structural lesions\\nII. Diagnosed by ultrasound\\nIII. Confirmed by histopathology\\nSelect the correct answer:',correct:'I and III only',options:['I and II only','I and III only','I, II and III','II and III only'],exp:'PALM-COEIN classification of AUB (FIGO 2011): PALM = structural causes (visible on imaging or histopathology): P = Polyp, A = Adenomyosis, L = Leiomyoma, M = Malignancy and hyperplasia. CHARACTERISTICS OF PALM: Statement I \u2714 \u2014 STRUCTURAL LESIONS: all PALM causes are structural\/anatomical abnormalities. Statement II \u2717 \u2014 NOT all diagnosed by ultrasound; Malignancy\/hyperplasia (the M in PALM) requires HISTOPATHOLOGICAL confirmation; adenomyosis may need MRI or histology; ultrasound alone is insufficient for all PALM causes. Statement III \u2714 \u2014 CONFIRMED BY HISTOPATHOLOGY: all PALM causes can\/should be confirmed histopathologically (polyp by polypectomy\/biopsy; adenomyosis by hysterectomy specimen; leiomyoma by pathology; malignancy by biopsy). COEIN = functional\/non-structural causes. Correct: I and III. Answer: I and III only.'},\n{id:66,stem:'Daily suppressive therapy for HSV-1 and HSV-2 is:',correct:'Acyclovir 400 mg twice daily',options:['Valacyclovir 1 g once daily','Acyclovir 400 mg once daily','Acyclovir 400 mg thrice daily','Acyclovir 400 mg twice daily'],exp:'Herpes simplex virus (HSV) suppressive therapy regimens: ACYCLOVIR for DAILY SUPPRESSION: 400 mg TWICE DAILY \u2714 \u2014 the standard CDC-recommended regimen for daily suppressive therapy; reduces recurrence frequency by 70\u201380%; reduces asymptomatic viral shedding. Alternative: Acyclovir 200 mg 5 times daily (older regimen). VALACYCLOVIR for suppression: 500 mg once daily OR 1 g once daily (for frequent recurrences). Valacyclovir 1 g once daily = suppressive but not the standard first choice described in this option. \"400 mg once daily\" = insufficient. \"400 mg thrice daily\" = episodic treatment dose. Standard suppressive = Acyclovir 400 mg TWICE daily. Answer: Acyclovir 400 mg twice daily.'},\n{id:67,stem:'Which of the following are the primary organisms involved in PID?\\nI. N. gonorrhoeae\\nII. Chlamydia\\nIII. Mycoplasma hominis\\nIV. Candida albicans\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Pelvic Inflammatory Disease (PID) \u2014 causative organisms: PRIMARY\/MOST IMPORTANT organisms: N. GONORRHOEAE \u2714 \u2014 sexually transmitted; ascends from the cervix; classic cause; gram-negative diplococcus. CHLAMYDIA TRACHOMATIS \u2714 \u2014 most common STI-associated PID organism in many regions; intracellular; often subclinical\/silent; causes tubal scarring. MYCOPLASMA HOMINIS \u2714 \u2014 a vaginal commensal that can ascend and contribute to upper genital tract infection; causes endometritis and salpingitis. Also: Mycoplasma genitalium (increasingly recognised), anaerobes (in more severe\/polymicrobial PID). CANDIDA ALBICANS \u2717 \u2014 Candida causes vulvovaginal CANDIDIASIS (thrush); it does NOT cause PID; it is a fungus not a bacterium and does not ascend to cause salpingitis. Correct: I, II, III. Answer: I, II and III.'},\n{id:68,stem:'What are the characteristics of dermoid cyst?\\nI. Germ cell ovarian tumour\\nII. Bilateral in 15-20% cases\\nIII. Torsion is common\\nIV. Rupture is common\\nSelect the correct answer:',correct:'I, II and III',options:['I and III only','II and IV only','II, III and IV','I, II and III'],exp:'Dermoid cyst (mature cystic teratoma) characteristics: Statement I \u2714 \u2014 GERM CELL tumour: derived from totipotential germ cells; contains ectodermal structures (skin, hair, sebaceous glands, teeth); most common benign ovarian tumour in young women. Statement II \u2714 \u2014 BILATERAL in 10\u201315% (some sources say up to 20%) of cases; important to examine the opposite ovary at surgery. Statement III \u2714 \u2014 TORSION is COMMON: dermoid cysts are prone to torsion because they are heavy (dense contents) and usually pedunculated\/mobile; torsion = most common complication (occurs in ~15%). Statement IV \u2717 \u2014 RUPTURE is NOT common (rare complication); rupture can cause chemical peritonitis from spilled sebaceous material; it is serious when it occurs but is uncommon. Correct: I, II, III. Answer: I, II and III.'},\n{id:69,stem:'Which one of the following is NOT a differential diagnosis of chronic inversion of uterus?',correct:'Gartner\\'s cyst',options:['Fibroid polyp','Fungating cervical malignancy','Cervical prolapse','Gartner\\'s cyst'],exp:'Chronic inversion of uterus \u2014 differential diagnoses (conditions that present as a mass protruding from the cervix\/vagina): FIBROID POLYP \u2714 \u2014 a submucous fibroid on a long pedicle can prolapse through the cervix; the mass feels firm, smooth; clinically similar to inversion. FUNGATING CERVICAL MALIGNANCY \u2714 \u2014 exophytic, friable, bleeding mass at the cervix; can mimic uterine inversion. CERVICAL PROLAPSE \u2714 \u2014 the cervix (and uterus) descends and protrudes from the vaginal introitus; palpation shows the mass is the cervix with uterus attached above. GARTNER\\'S CYST \u2717 \u2014 a remnant of the mesonephric (Wolffian) duct; appears as a small CYSTIC swelling on the ANTEROLATERAL VAGINAL WALL; it does NOT present as a mass prolapsing from the cervix; NOT a differential of uterine inversion. Answer: Gartner\\'s cyst.'},\n{id:70,stem:'A 28-year-old P\u2082L\u2082 presents to Gynaecology OPD with complaints of malodorous vaginal discharge. On examination, the discharge was found to be grayish-white in colour and adherent to vaginal walls. Which one of the following is a bedside diagnostic criterion for the causative organism?',correct:'Positive 10% potassium hydroxide test',options:['Presence of RBCs in vaginal smear','Vaginal pH < 4.5','Positive 10% potassium hydroxide test','Positive NAAT test'],exp:'Bacterial Vaginosis (BV): grayish-white, homogeneous, malodorous discharge adherent to vaginal walls. Amsel\\'s criteria (3 of 4 for diagnosis): Vaginal pH >4.5 \u2714 (NOT <4.5 \u2014 option b is wrong). POSITIVE WHIFF TEST (10% KOH\/positive potassium hydroxide test) \u2714 \u2014 adding 10% KOH to vaginal discharge releases amines (fishy\/amine odour) from Gardnerella and anaerobes; POSITIVE KOH test = whiff test positive = a BEDSIDE diagnostic criterion. Clue cells >20% on wet mount. Homogeneous thin discharge. NAAT (nucleic acid amplification): detects Gardnerella\/BV-associated bacteria but is NOT a bedside test. RBCs: not a BV criterion. Vaginal pH <4.5 = NORMAL\/candidiasis (NOT BV). The bedside criterion = positive 10% KOH (whiff) test. Answer: Positive 10% potassium hydroxide test.'},\n{id:71,stem:'Which of the following statements about hysterosalpingography, as an operative procedure, are correct?\\nI. Tubal patency assessment following tuboplasty operation\\nII. Diagnosis of uterine synechiae\\nIII. Detection of IUD\\nIV. Diagnosis of subserosal fibroid\\nSelect the answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Hysterosalpingography (HSG) \u2014 indications and uses: TUBAL PATENCY after tuboplasty \u2714 \u2014 HSG assesses tubal patency following reconstructive tubal surgery; contrast should fill and spill freely. UTERINE SYNECHIAE (Asherman\\'s syndrome) \u2714 \u2014 intrauterine filling defects on HSG indicate adhesions\/synechiae; irregular outline of uterine cavity. DETECTION OF IUD \u2714 \u2014 HSG can localise a \"lost\" or malpositioned IUD; though ultrasound and X-ray are more common, HSG can demonstrate the IUD position relative to the uterine cavity. SUBSEROSAL FIBROID \u2717 \u2014 HSG is excellent for SUBMUCOSAL fibroids (distort the uterine cavity \u2192 filling defect) and intracavitary polyps; however SUBSEROSAL fibroids are OUTSIDE the uterine cavity and do NOT distort the cavity outline \u2192 NOT diagnosed by HSG (USS\/MRI for subserosal fibroids). Correct: I, II, III. Answer: I, II and III.'},\n{id:72,stem:'Which of the following are indications of endometrial sampling?\\nI. Endometrial tuberculosis\\nII. Endometrial polyp\\nIII. Postmenopausal bleeding\\nIV. Abnormal uterine bleeding\\nSelect the correct answer:',correct:'I, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Endometrial sampling (Pipelle\/D&C\/hysteroscopy with biopsy) indications: ENDOMETRIAL TUBERCULOSIS \u2714 \u2014 endometrial biopsy is used to diagnose TB endometritis; histology shows granulomas; TB culture from sample; menstrual blood culture for AFB. POSTMENOPAUSAL BLEEDING \u2714 \u2014 MANDATORY indication; must exclude endometrial carcinoma\/hyperplasia; any postmenopausal bleeding requires endometrial sampling. ABNORMAL UTERINE BLEEDING \u2714 \u2014 particularly in women >40 years or those with risk factors; to exclude endometrial pathology. ENDOMETRIAL POLYP \u2717 \u2014 polyps are diagnosed by ultrasound (saline infusion sonohysterography) or hysteroscopy; endometrial SAMPLING alone (Pipelle) may MISS a polyp (small surface area sampled); the treatment of a polyp is HYSTEROSCOPIC POLYPECTOMY, not mere sampling. While biopsy is taken at the time of polypectomy, polyp diagnosis itself is not an indication FOR sampling per se. Correct: I, III, IV. Answer: I, III and IV.'},\n{id:73,stem:'A 30-year-old P\u2083L\u2083 female presents in Gynaecology emergency with acute abdominal pain and vaginal bleeding of short duration (1 hour). She gives history of tubal ligation after birth of third child. On examination, right adnexal tenderness was found and os was closed. What is the probable diagnosis?',correct:'Ectopic pregnancy',options:['Ectopic pregnancy','Pelvic inflammatory disease','Appendicitis','Complete abortion'],exp:'ECTOPIC PREGNANCY despite history of tubal ligation: KEY CLUES: P3L3 with TUBAL LIGATION \u2014 sterilisation failure (especially if performed via ligation, clips, or rings); failure rate ~0.5\u20131 per 100 woman-years; when tubal ligation fails, the resulting pregnancy is MORE LIKELY TO BE ECTOPIC (approximately 50% of failures). Closed OS \u2714 \u2014 rules out spontaneous abortion (open os). Right adnexal tenderness \u2714 \u2014 suggestive of right tube ectopic. Acute abdominal pain + vaginal bleeding + closed os + adnexal tenderness = ECTOPIC PREGNANCY. PID: no closed os restriction; bilateral tenderness; fever; discharge. Appendicitis: no vaginal bleeding; right iliac fossa pain; no adnexal mass. Complete abortion: open os; all POC expelled. Answer: Ectopic pregnancy.'},\n{id:74,stem:'Which of the following statements are correct regarding audit in Obstetrics and Gynaecology?\\nI. It can replace the out of date clinical practices with better ones\\nII. It is an efficient educational tool\\nIII. It should be based on scientific evidences with facts and figures\\nIV. It is not labour-intensive\\nSelect the answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Clinical audit in Obstetrics and Gynaecology: Statement I \u2714 \u2014 Clinical audit is the AUDIT CYCLE: measures current practice against standards \u2192 identifies gaps \u2192 implements changes \u2192 RE-AUDIT; this process REPLACES outdated practices with evidence-based better ones. Statement II \u2714 \u2014 EDUCATIONAL TOOL: audit teaches trainees about best practices, clinical standards, quality improvement methodology; raises awareness of where care falls short. Statement III \u2714 \u2014 Audit should be based on EVIDENCE-BASED STANDARDS (clinical guidelines, NICE\/RCOG protocols) with objective data \u2014 facts and figures; not opinion-based. Statement IV \u2717 \u2014 Clinical audit IS labour-intensive: it requires data collection, analysis, implementation of changes, and re-audit; it demands significant time and resources from clinical teams. Correct: I, II, III. Answer: I, II and III.'},\n{id:75,stem:'Which of the following are poor prognostic factors in endometrial adenocarcinoma?\\nI. Estrogen and progesterone receptor positivity\\nII. HER-2\/neu gene expression\\nIII. Histologic types papillary serous or clear cell carcinoma\\nIV. Aneuploid tumours\\nSelect the correct answer:',correct:'II, III and IV',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Endometrial carcinoma \u2014 poor prognostic factors: Statement I \u2717 \u2014 ER\/PR POSITIVITY is a GOOD prognostic factor; receptor-positive tumours are well-differentiated (Type I), respond to progestin therapy, and have better outcomes. Statement II \u2714 \u2014 HER-2\/NEU OVEREXPRESSION: poor prognosis; associated with serous carcinoma, high-grade tumours, advanced stage; HER-2 positive \u2192 aggressive behaviour. Statement III \u2714 \u2014 PAPILLARY SEROUS and CLEAR CELL carcinoma = TYPE II endometrial cancers; high grade, aggressive; deep myometrial invasion; early metastasis; much worse prognosis than endometrioid carcinoma. Statement IV \u2714 \u2014 ANEUPLOIDY (abnormal DNA content) = poor prognosis; aneuploid tumours are more aggressive, higher grade, more likely to recur. Correct: II, III, IV. Answer: II, III and IV.'},\n{id:76,stem:'For which of the following conditions, surgery is indicated in a case of Fibroid Uterus?\\nI. Symptomatic and failed medical management\\nII. Size > 12 weeks\\nIII. Pedunculated fibroid\\nSelect the correct answer:',correct:'I and II only',options:['I, II and III','I and II only','II and III only','I and III only'],exp:'Surgical indications for uterine fibroids: Statement I \u2714 \u2014 SYMPTOMATIC FIBROIDS (AUB, pressure symptoms, infertility, recurrent miscarriage) that have FAILED MEDICAL MANAGEMENT \u2014 the primary surgical indication. Statement II \u2714 \u2014 SIZE >12 WEEKS uterine size: fibroids causing significant uterine enlargement (>12 weeks\/300g) warrant surgery, especially if symptomatic; also for concern about masking ovarian pathology and obstruction. Statement III \u2717 \u2014 PEDUNCULATED FIBROID per se is NOT an independent indication for surgery; pedunculated subserosal fibroids are often asymptomatic; pedunculated submucosal (intracavitary) fibroids causing AUB would fall under \"symptomatic\" (Statement I). A pedunculated fibroid without symptoms does not require surgery. Correct: I and II. Answer: I and II only.'},\n{id:77,stem:'Which of the following is measured without any straining while examination under POP-Q system?',correct:'TVL',options:['TVL','Pb','GH','Point D'],exp:'POP-Q (Pelvic Organ Prolapse Quantification) system measurements: TVL (Total Vaginal Length) \u2714 \u2014 measured WITHOUT straining\/Valsalva; represents the total length of the vagina from the hymen to the posterior vaginal fornix (or vaginal vault in post-hysterectomy); recorded at REST. All OTHER POP-Q measurements (Aa, Ba, C, D, Ap, Bp, GH, Pb) are measured WITH MAXIMUM VALSALVA\/STRAINING: GH (Genital Hiatus): measured at maximum Valsalva. Pb (Perineal Body): measured at maximum Valsalva. Point D (posterior vaginal fornix): measured with Valsalva. Points Aa, Ba, C, Ap, Bp: all with Valsalva. TVL is the ONLY POP-Q measurement made at rest (without straining). Answer: TVL.'},\n{id:78,stem:'Which of the following are criteria for opting Le Fort\\'s operation for surgical correction of pelvic organ prolapse?\\nI. Procidentia in old age\\nII. Unfit for long duration surgery\\nIIII. Associated uterine pathology\\nIV. Coital function no longer required\\nSelect the correct answer:',correct:'I, II and IV',options:['I, III and IV','I and II only','II, III and IV','I, II and IV'],exp:'Le Fort\\'s colpocleisis operation \u2014 criteria\/indications: It is an OBLITERATIVE procedure (partial colpocleisis): suitable for elderly women with PROCIDENTIA who no longer require vaginal coitus. PROCIDENTIA IN OLD AGE \u2714 \u2014 ideal candidates; elderly frail patients with complete uterovaginal prolapse. UNFIT FOR LONG DURATION SURGERY \u2714 \u2014 Le Fort\\'s is a relatively quick, simple procedure under regional anaesthesia; suitable for patients who cannot tolerate prolonged surgery. COITAL FUNCTION NO LONGER REQUIRED \u2714 \u2014 ABSOLUTE requirement; the vaginal canal is largely obliterated \u2192 sexual intercourse is no longer possible after the procedure; patient and partner must consent to this. ASSOCIATED UTERINE PATHOLOGY \u2717 \u2014 if there is suspected\/confirmed uterine pathology (fibroids, malignancy), Le Fort\\'s is CONTRAINDICATED; it leaves the uterus in situ and creates a vaginal canal for drainage monitoring; any pathology cannot be managed and could be masked. Correct: I, II, IV. Answer: I, II and IV.'},\n{id:79,stem:'Opening of Bartholin\\'s duct is in the:',correct:'vestibule outside the hymen at the junction of the anterior 2\/3rd and posterior 1\/3rd in the groove between the hymen and labium minus',options:['vestibule outside the hymen at the junction of the anterior 2\/3rd and posterior 1\/3rd in the groove between the hymen and labium minus','groove between labia majora and labia minora','superficial perineal pouch at the junction of anterior 1\/3rd and post 1\/3rd','periurethral region in anterior 1\/3rd of labia minora'],exp:'Bartholin\\'s gland (greater vestibular gland) anatomy: GLAND: lies in the posterior part of the labium majus, superficial to the perineal membrane (urogenital diaphragm). DUCT: approximately 2 cm long; opens into the VESTIBULE (outside the hymen) at the JUNCTION OF THE ANTERIOR 2\/3 AND POSTERIOR 1\/3 of the groove between the hymen and labium minus \u2714 (at approximately 4 o\\'clock and 8 o\\'clock positions). This is a high-yield anatomical fact: opening is in the groove between hymen and labium minus, at the junction of anterior 2\/3 and posterior 1\/3. Answer: Vestibule outside the hymen at the junction of the anterior 2\/3rd and posterior 1\/3rd in the groove between the hymen and labium minus.'},\n{id:80,stem:'Which of the following are Amsel\\'s diagnostic criteria?\\nI. Vaginal pH > 4.5\\nII. Positive Whiff test\\nIII. Presence of clue cells > 20%\\nIV. Positive bacterial vaginal culture\\nSelect the correct answer:',correct:'I, II and III',options:['I, II and III','I, II and IV','I, III and IV','II, III and IV'],exp:'Amsel\\'s criteria for BACTERIAL VAGINOSIS (3 of 4 required for diagnosis): VAGINAL pH >4.5 \u2714 (Statement I) \u2014 loss of Lactobacillus acid production \u2192 alkaline pH. POSITIVE WHIFF TEST \u2714 (Statement II) \u2014 fishy amine odour released when 10% KOH added to discharge (positive potassium hydroxide test). CLUE CELLS >20% \u2714 (Statement III) \u2014 epithelial cells studded with Gardnerella\/anaerobes; stippled appearance on wet mount; >20% clue cells of all epithelial cells. HOMOGENEOUS THIN GREY\/WHITE DISCHARGE (4th criterion \u2014 not listed here). BACTERIAL VAGINAL CULTURE \u2717 (Statement IV) \u2014 bacterial culture is NOT one of Amsel\\'s criteria; Gardnerella vaginalis cultures are not specific (it is part of normal flora); culture is not used clinically for BV diagnosis. Correct Amsel\\'s criteria: I, II, III. 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Submitting in 10 Submit Now Combined Medical Services Examination 2025Paper II \u00b7 Part B Gynaecology & Obstetrics (Q41 \u2013 Q80) Questions 41 \u2013 80 +1 correct \u00b7 \u2212\u2153 wrong \u23f1 Start Timed Mode Submit Answers 0%score Your Result \u21ba Retry… <\/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-36844","post","type-post","status-publish","format-standard","hentry","category-cms","category-obg"],"yoast_head":"\n<title>CMS 2025 P2 Part-B - atsixty<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/atsixty.com\/index.php\/2026\/05\/16\/cms-2025-p2-part-b\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CMS 2025 P2 Part-B - atsixty\" \/>\n<meta property=\"og:description\" content=\"CMS 2025 Paper II \u2013 Part B (Q41\u2013Q80) \u23f1 40:00 \u2705 0 \u274c 0 \u23f3 40 left Net 0.00 \/ 40 Time's Up! 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