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Obstetrics and Gynecology Multiple Choice Questions
1. In three tier system of CTG interpretation, category III abnormal CTG is all EXCEPT
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a. Absent baseline FHR variability and recurrent late deceleration
b. Absent baseline FHR variability and recurrent variable deceleration
c. Absent baseline FHR variability and bradycardia
d. Prolonged deceleration > 2 min but < 10 min
Answer: d
2. Absolute contraindications to neuraxial analgesia in labour include all EXCEPT
a. Maternal coagulopathy
b. Thrombocytopenia
c. Prophylactic low-molecular-weight heparin within 12 hours
d. Refractory maternal hypertension
Answer: d
3. Proven contraindications for the use of PGE2 for induction of labour include all EXCEPT
a. suspicion of fetal compromise
b. bronchial asthma
c. unexplained vaginal bleeding
d. cephalopelvic disproportion
Answer: b
4. McRobert’s maneuver for relieving shoulder dystocia acts by all the following EXCEPT
a. straightening of the sacrum relative to the lumbar vertebrae
b. rotation of the symphysis pubis toward the maternal head
c. decrease in the angle of pelvic inclination
d. increase in overall pelvic dimensions
Answer: d
5. All the following statements are TRUE EXCEPT
a. Case-control studies are most feasible for examining the association between a relatively common exposure and a relatively rare disease
b. Strengths of cohort studies include the ability to obtain attributable and relative risks (RRs) because the occurrence of the outcome is being compared in two groups
c. Phase 3 clinical trials determine the efficacy of treatment for the intended population, compared with other available treatments, assess adverse events and side effects
d. The negative predictive value (NPV) and positive predictive value (PPV) of a test does not vary with the baseline characteristics of population or prevalence of a disease
Answer: d
6. The FALSE statement regarding trichomonial vaginitis is
a. Increased risk of PPROM and PTL in pregnant women and higher post hysterectomy cuff infection
b. Less than 10% of men contract the disease after a single exposure to an infected woman
c. T. vaginalis infection is associated with a two to three fold increased risk for HIV acquisition
d. Clue cells and Whiff test may be positive in TV
Answer: b
7. Find the FALSE statement regarding cervicitis
a. The microbial etiology of endocervicitis is unknown in about 50% of cases in which neither gonococci nor chlamydia is detected
b. Mycoplasma genitaliem, can be detected in 10% to 30% of women with clinical cervicitis
c. Nucleic acid amplification tests (NAAT) for gonorrhea and chlamydia, is not mandatory in all cases
d. Cervicitis is commonly associated with BV, which if not treated concurrently, leads to significant persistence
Answer: c
8. All the statements regarding PID are TRUE EXCEPT
a. About 75% of women with tubo-ovarian abscess do not respond to antimicrobial therapy alone and need drainage
b. No definite symptoms are defined to diagnose PID
c. Evaluation of both vaginal and endocervical secretions is a crucial part of the workup of a patient with PID
d. Additional criteria to increase the specificity of the diagnosis include endometrial biopsy, CRP and positive test for gonorrhea or chlamydia and laparoscopy
Answer: a
9. Regarding genital ulcers find the TRUE statement
a. The ulcer of syphilis has irregular margins and is deep with undermined edges
b. The chancroid ulcer has a smooth, indurated border and a smooth base
c. The genital herpes ulcer is often multiple, sub-epidermal and inflamed
d. If inguinal buboes with no ulcer is present, the most likely diagnosis is LGV
Answer: d
10. Regarding testing in genital ulcers which of the following statements is FALSE
a. (VDRL) test and a confirmatory treponemal test – fluorescent treponemal antibody absorption (FTA ABS) or microhemagglutinin-T. pallidum should be used to diagnose syphilis presumptively in all cases
b. HSV culture sensitivity approaches 100% in the vesicle stage but PCR assays for HSV DNA are more sensitive in the ulcerative stage
c. Optimally, the evaluation of a patient with a genital ulcer should include culture for Haemophilusducreyi
d. The diagnosis remains unconfirmed in more than half of patients (60%) with genital ulcers
Answer: d
11. Medical management of endometriosis – Find the FALSE statement
a. Approximately 85% of women with endometriosis and pelvic pain who are treated with GnRH agonists experience relief of their pain
b. Dienogest is effective in improving endometriosis-associated pain and may even help overcome progesterone resistance by increasing the number of progesterone receptors
c. Estrogen-progestin contraceptives is cytoreductive and halts progression of endometriosis in upto 90% of affected women when taken continuously
d. The levonorgestrel-releasing intrauterine device is of value in women with deep infiltrating rectovaginal endometriosis in reducing pain and dysmenorrhea recurrence following surgical therapy
Answer: c
12. Find the INCORRECT statement regarding Ectopic pregnancy
a. the overall risk of recurrence is approximately 10% for women with one previous ectopic pregnancy and at least 25% for women having two or more
b. estrogen-progestin contraceptives and vasectomy are associated with the lowest absolute incidence of ectopic pregnancy (0.005 ectopic pregnancies/1,000 women years)
c. if pregnancy does occur with an IUD in situ, the risk for ectopic pregnancy is as high as 80%
d. approximately one-third of all pregnancies resulting from sterilization failure are ectopic
Answer: c
13. Medical Management of Ectopic pregancy-Find INCORRECT statement
a. In 85% cases, serum β-hCG concentrations rise somewhat between days 1 and 4 and does not necessarily indicate failed treatment
b. Medical treatment is not contraindicated for ectopic pregnancies with serum β-hCG concentrations greater than 5,000 IU/L or presence of embryonic heart activity, but the likelihood of treatment failure and the risk of tubal rupture are increased substantially
c. Anti D immunoglobulin need be administered only tononsensitized Rh-negative women with ectopic pregnancy undergoing surgical management
d. Free peritoneal fluid may be observed in almost 40% of women with early unruptured ectopic pregnancies and that the presence or absence of cul-de-sac fluid does not accurately predict the success or failure of medical treatment
Answer: c
14. Fetoplacental blood volume at term is approximately
a. 125 ml/kg of fetal weight
b. 80 ml/kg of fetal weight
c. 45 ml/kg of fetal weight
d. 240 ml/kg of fetal weight
Answer: a
15. Find the INCORRECT statement regarding international guidelines on vaccination in pregnancy
a. A dose of tetanus-diphtheria-acellular pertussis (Tdap) is ideally given to gravidas between 27 and 36 weeks’ gestation
b. All women who will be pregnant during influenza season should be offered vaccination, regardless of gestational age
c. Avoid becoming pregnant for atleast one month after MMR vaccination
d. HPV vaccination may be administered to high risk pregnant women after the first trimester of pregnancy
Answer: d
16. The FALSE statement regarding fetal biometry by USS is
a. Until 14 weeks’ gestation, the Crown-Rump Length (CRL) is accurate to within 5 to 7 days
b. The biparietal diameter (BPD) most accurately reflects gestational age, with a variation of 7 to 10 days in the second trimester
c. If the head shape is flattened-dolichocephaly or rounded brachycephaly, the Head Circumference (HC) is more reliable than the BPD
d. To measure the AC, a circle is placed outside the fetal skin in a transverse image that contains the stomach, the kidneys and the confluence of the umbilical vein with the portal sinus
Answer: d
17. All the following are indications for fetal ECHO EXCEPT
a. thick nuchal translucency
b. monochorionic twin gestation
c. maternal anti cardiolipin antibodies
d. maternal pregestational diabetes orphenylketonuria
Answer: c
18. Fetal renal pelviectasis – Find the CORRECT statement
a. is present in 20 to 30 percent of fetuses
b. in 30 percent of cases, it is transient or physiological
c. the pelvis is typically considered dilated if it exceeds 4 mm in the second trimester or 7 mm at approximately 32 weeks’ gestation
d. mild pyelectasis in the second trimester is not considered a soft marker for down syndrome
Answer: c
19. All the statements about Hydramnios (Polyhydramnios) are TRUE EXCEPT
a. it is diagnosed when AFI exceeds 24 and complicates 1 to 2 percent of singleton pregnancies
b. underlying causes of hydramnios include fetal anomalies-in approximately 15 percent and diabetes in 15 to 20 percent
c. the degree of hydramnios correlates with the likelihood of an anomalous infant
d. idiopathic hydramnios accounts for upto 30 percent of cases of hydramnios
Answer: d
20. Find the FALSE statement regarding teratogens in pregnancy
a. less than 1 percent of all birth defects are caused by medications
b. 80 percent of birth defects do not have an obvious etiology and of those withan identified cause, nearly 95 percent of cases have chromosomal or genetic origins
c. mono therapy with Levitracetam is associated with a 8-percent major malformation rate, which is slightly higher than that for the general population
d. sulfonamides and nitrofurantoin are appropriate for use in pregnancy only if suitable alternatives are lacking
Answer: c
21. The following structures may be injured during sacrospinous ligament fixation EXCEPT
a. Pudendal nerve
b. Superior gluteal artery
c. Inferior gluteal artery
d. Internal pudendal vessels
Answer: b
22. All the following statements about ureteric injury are TRUE EXCEPT
a. 75% of all iatrogenic injuries to the ureter result from gynecologic procedures
b. Laparoscopic hysterectomies have the least rate of ureteral injuries and vaginal hysterectomies the highest
c. Ninety-one percent of injuries occur at the level of the pelvicureter and only 2% and 7% occur at the upper and middle ureteral thirds
d. Careful identification of the ureter before securing the infundibulopelvic ligament and uterine artery is the best protection against ureteric injury during hysterectomy
Answer: b
23. All are TRUE regarding Dermoid cysts of ovary EXCEPT
a. Malignant transformation occurs in less than 2% of dermoid cysts in women of all ages
b. Upto 25% of dermoids occur in postmenopausal women
c. The risk of torsion with dermoid cysts is approximately 50%
d. They are bilateral in approximately 10% of cases
Answer: c
24. All are TRUE regarding Endometrial Intraepithelial Neoplasia (EIN) EXCEPT
a. Approximately 40% to 50% of women with atypical hyperplasia or EIN have concurrent carcinoma
b. The risk of progression of hyperplasia without atypia to cancer is low but is approximately 30% among those with atypical hyperplasia
c. Infertile women with EIN treated with high dose progestins should have an endometrial biopsy every 3 months
d. For women with EIN treated with progestins, recurrence risks approach 10%
Answer: d
25. According to the FIGO fibroid classification system type 3 is
a. 50% or more of the fibroid diameter within the myometrium
b. Intramural and entirely within the myometrium, without extension to either the endometrial surface or to the serosa
c. Abuts the endometrium without any intracavitary component
d. Located in cervix or broad ligament
Answer: c
26. All are TRUE about atypical leiomyomas EXCEPT
a. Mitotically active leiomyoma is defined by the presence of 5 to 10 mitoses/10 high-power fields and may be found in pregnancy and OCP users
b. Cellular leiomyomas exhibiting chromosome 1p deletions, may be clinically more aggressive
c. STUMP shows atypical histologic features that range between leiomyoma and LMS but the mitotic count is less than 10/10 hpf
d. STUMP mostly those that are p53 and p16 positive, have been found to exhibit malignant potential to develop a low-grade LMS
Answer: a
27. Contraindications to Uterine Artery Embolisation (UAE) include all EXCEPT
a. desirous of future fertility
b. impaired renal dysfunction
c. diminished immune status
d. willingness for hysterectomy
Answer: d
28. The pharmacologic treatments for vulvodynia can include topical lidocaine 5% with any of the following EXCEPT
a. oral gabapentine and steroids
b. botulinum toxin injections
c. combined oestrogen and progesterone pills
d. menopausal hormone therapy
Answer: c
29. Find the INCORRECT statement about Chronic Pelvic Pain (CPP)
a. There appears to be no relationship between the incidence and severity of pain or the stage of the endometriotic lesions
b. The specific location and density of pelvic adhesions correlates consistently with the presence of pain symptoms
c. Endometriosis can be demonstrated in 15% to 40% of patients undergoing laparoscopy for CPP
d. The accuracy of ultrasound in detecting ovarian remnant syndrome can be improved by treating the patient with a 5- to 10-day course of clomiphene citrate
Answer: b
30. Find the FALSE statement regarding elagolix
a. used to suppress the estrogen production to a level that is adequate for symptom relief but minimizes hypoestrogenic effects
b. cannot produce a dose-dependent suppression of pituitary function and ovarian hormones like GnRH agonists
c. improves dysmenorrhea and nonmenstrual pelvic pain during a 6-month period in women with endometriosis-associated pain
d. orally active GnRH antagonist with no flare effect
Answer: b
31. All are TRUE regarding serous borderline ovarian tumours EXCEPT
a. 10% of all ovarian serous tumors are of borderline type and 50% occur before the age of 40 years
b. Up to 40% of serous borderline tumors are associated with spread beyond the ovary
c. Up to 10% of women with ovarian serous borderline tumors and extraovarian implants may have invasive implants
d. Borderline serous tumors may harbor foci of stromal microinvasion and if so, should be managed as aggressive serous carcinomas
Answer: d
32. In Kyoto (Querlou and Morrow) classification, Nerve sparing Radical Hysterectomy is
a. Type B
b. Type C1
c. Type C2
d. Type D2
Answer: b
33. All are TRUE about Germ cell tumours EXCEPT
a. In patients with stage IA dysgerminoma, unilateral oophorectomy alone results in a 5-year disease-free survival rate of greater than 95%
b. Patients with stage IA, grade 1 immature teratoma need 4 cycles of BEP adjuvant therapy after surgery
c. All patients with Endodermal Stromal Tumours (EST) should be treated with chemotherapy shortly after recovering from surgery ovarian dysfunction of failure
d. Transient ovarian failure is common with platinum-based chemotherapy for germ cell tumours and majority will have successful childbearing in the future
Answer: b
34. All the following statements regarding Granulosa cell tumours of the ovary are TRUE EXCEPT
a. Endometrial cancer occurs in association with granulosa cell tumors in at least 5% of cases
b. 25-50% of Granulosa cell tumours are associated with endometrial hyperplasia
c. Granulosa cell tumors may also produce androgens and cause virilization
d. Juvenile granulosa cell tumors of the ovary are rare and behaves more aggressively than the adult type
Answer: d
35. All the following statements about intrahepatic cholestasis of pregnancy are TRUE EXCEPT
a. bile acids are cleared incompletely and accumulate in plasma but the cause is unclear
b. pruritus shows predilection for the soles and may precede laboratory findings by several weeks
c. total plasma concentrations of bilirubin exceed 8 mg/dL and serum transaminases exceed 500 in 30% patients
d. ursodeoxycholic acid relieves pruritus and improves fetal outcome better than steroids and cholestyramine
Answer: c
36. All the statements about sickle cell anaemia in pregnancy are TRUE EXCEPT
a. Sickle-cell trait does not appear to be associated with increased perinatal mortality, low birthweight or pregnancy-induced hypertension
b. In Sickle cell disease there is no categorical contraindication to vaginal delivery, and caesarean delivery is reserved for obstetrical indications
c. Routine prophylactic blood transfusions during labour is recommended to reduce painful crises in Sickle cell anaemia
d. Antenatal folic acid supplementation with 4 mg daily throughout pregnancy is needed to support rapid red blood cell turnover
Answer: c
37. All the statements about thrombocytopenia in pregnancy are TRUE EXCEPT
a. A platelet count of < 80,000/L should trigger an evaluation for etiologies other than gestational thrombocytopenia
b. Hypertensive disorders account for 21% of thrombocytopenia in pregnancy
c. In ITP complicating pregnancy, therapy with steroids is considered if the platelet count is below 30,000 to 50,000/L
d. Maternal platelet counts have strong correlation with fetal platelet counts and caesarean delivery is recommended if platelet count is < 50,000 on fetal blood sampling
Answer: d
38. All the following statements regarding diabetes in pregnancy are TRUE EXCEPT
a. Periconceptional HbA1C should be kept under 6.5% in pregestational diabetic women
b. MSAFP levels may be lower in diabetic pregnancies and the incidence of congenital cardiac anomalies is five fold in mothers with diabetes
c. Ultra short acting insulin analogues starts acting in 30 minutes, peaks in 2 hrs minutes and is good for preprandial glycemic control in pregnancy
d. Insulin therapy is typically added if fasting levels persistently exceed 95 mg/dL after medical nutrition therapy
Answer: c
39. All the statements about thyroid in pregnancy are TRUE EXCEPT
a. Women with TPO antibodies are at increased risk for progression of thyroid disease and postpartum thyroiditis
b. It is recommended that women avoid pregnancy for 1 month after radioablative therapy with iodine 131
c. Pregnancy is associated with an increased thyroxine requirement in approximately a third of supplemented women
d. Prophylthiouracil (PTU) is preferred in pregnancy because it partially inhibits the conversion of T4 to T3 and crosses the placenta less readily than methimazole
Answer: b
40. All the statements about SLE in pregnancy are TRUE EXCEPT
a. Fetal cell micro chimerism leads to the predilection for autoimmune disorders like SLE among women
b. In the presence of anti-Ro and Anti-La antibodies, the incidence of fetal myocarditis and heart block is as high as 20%
c. During pregnancy, lupus improves in a third of women, remains unchanged in a third and worsens in the remaining third
d. Hydroxychloroquine is not associated with congenital malformations and can be continued in pregnancy
Answer: b
41. Identify the FALSE statement regarding Test for Ovarian Reserve
a. Total number of antral follicles measuring 2-10 mm in both ovaries is proportional to the number of primordial follicles remaining
b. Small antral follicles (2-6 mm) are likely the primary source of AMH because they contain larger numbers of granulosa cells and a more developed microvasculature
c. Recent studies suggest AMH levels decrease with the use of oral contraceptives and GnRH agonists
d. A single elevated Day -3 FSH concentration (>10 IU/L) has high specificity for predicting poor response to stimulation or failure to achieve pregnancy
Answer: d
42. Find the FALSE statement
a. The prevalence of uterine anomalies in infertile women and fertile women with normal reproductive outcomes is similar, approximately 2-4%
b. Submucousmyomas reduce IVF success rates by approximately 70% and intramural myomas by approximately 20-40%
c. Hysteroscopic polypectomy may improve reproductive performance in infertile women
d. Conception and term delivery rates after successful hysteroscopiclysis of intrauterine adhesions are > 80%
Answer: d
43. The FALSE statement regarding Male infertility is
a. 2-5% of men with severe oligospermia and 8% of men with azoospermia may have Y chromosome microdeletions
b. Hyperprolactinemia and treatment with GnRH analogs or androgens can cause hypogonadotropic hypogonadism in males
c. Men with idiopathic infertility have significantly lesser CAG trinucleotide repeat lengths in androgen receptor gene
d. Disorders of estrogen synthesis or action may be associated with infertility in men
Answer: c
44. Risk factors for Ovarian Hyperstimulation Syndrome (OHSS) include all EXCEPT
a. Young age
b. Higher BMI
c. Higher AMH and AFC
d. Higher serum Oestradiol
Answer: b
45. Preimplantation Genetic Testing (PGT) – Find the FALSE statement
a. Can be used to detect numerical chromosomal aneuploidies and monogenic disorders but not structural rearrangements
b. Chromosomal composition of the oocyte may be inferred from that of the extruded polar bodies
c. One or two blastomeres may be removed from cleavage stage embryos
d. Biopsy of the trophectoderm can be performed at the blastocyst stage and has become the most commonly used technique
Answer: a
46. All are TRUE regarding cell free fetal DNA EXCEPT
a. Reliably detected in maternal blood after 9 to 10 weeks’ gestation
b. The proportion of cell-free DNA that is placental is called the fetal fraction and it composes approximately 50 percent of the total circulating cell-free DNA in maternal plasma
c. The specificity to detect down syndrome, trisomy 18 and trisomy 13 is over 99 percent
d. Real-time quantitative polymerase chain reaction (PCR) may be used for Rh genotyping, detection of paternally inherited single-gene disorders or fetal sex determination
Answer: b
47. All are TRUE regarding Prenatal Diagnosis EXCEPT
a. Biopsy of chorionic villi is typically performed between 10 and 13 weeks’ gestation
b. Transabdominal amniocentesis is generally done between 11 and 14 weeks
c. FISH studies are usually completed within 24 to 48 hours
d. Chromosomal MicroArray can often be performed directly on uncultured amniocytes with a turn around time of only 3 to 5 days
Answer: b
48. All are TRUE regarding Anti D immunoglobulin EXCEPT
a. 300 mcg dose is given for each 15 mL of fetal red cells or 30 mL of fetal whole blood to be neutralized
b. Anti-D immune globulin may produce a weakly positive-1 : 1 to 1 : 4-indirect coombs titer in the mother
c. Routine postpartum administration of anti-D immune globulin to at-risk pregnancies within 72 hours of delivery lowers the alloimmunization rate by 50 percent
d. Antepartum anti-D immune globulin at 28 weeks’ gestation reduces the third-trimester alloimmunization rate from approximately 2 percent to 0.1 percent
Answer: c
49. All are TRUE regarding Non-Stress Test NST EXCEPT
a. Before 32 weeks, normal accelerations are defined as having an acme that is 10 bpm or more above baseline for 10 seconds or longer
b. Beat-to-beat variability is under the control of the autonomic nervous system
c. Loss of reactivity is most commonly associated with fetal hypoxia
d. Abnormal non-stress test is inadequate to preclude any acuteasphyxial event happening in a 7 day interval
Answer: c
50. All are TRUE regarding miscarriage EXCEPT
a. balanced structural chromosomal rearrangements may originate from either parent and are found in 2 to 4 percent of couples with recurrent pregnancy loss
b. the incidence of euploid abortion rises dramatically after maternal age exceeds 35 years
c. a threshold CRL of 5 mm with absent cardiac activity is used to diagnose non-viability or embryonic demise
d. absence of an embryo in a sac with a mean sac diameter (MSD) 25 mm signifies an embryonic pregnancy
Answer: c
51. All are TRUE statements regarding female sterilisation in India EXCEPT
a. Laparoscopic tubal ligation can be done concurrently with second-trimester abortion and in the post-partum period only by an expert operator
b. The consent of the spouse is not required for sterilization
c. Clients should be married with female client below the age of 49 years and above the age of 22 years
d. The couple need have minimum one child whose age is above one year unless the sterilization is medically indicated
Answer: a
52. All the following statements are TRUE EXCEPT
a. BMI greater than 35 or weight greater than 100 kg, should receive 2 g of cefazolin as preoperative antibiotic prophylaxis
b. In as many as 50% of postoperative patients, Febrile morbidity in first 48 hours is noninfectious and does not need antibiotics
c. Even a single dose of perioperative prophylactic antibiotic decreases the incidence of postoperative urinary tract infection from 40% to as low as 4%
d. Incidence of wound infections could be decreased by hexachlorophene showers before surgery and shaving of the woundsite just prior to incision
Answer: d
53. All the following are TRUE about Enhanced Recovery-ERAS Protocol EXCEPT
a. Preoperative carbohydrate loading
b. The use of liberal antiemetics including preoperative steroids
c. Avoiding routine nasogastric tube and drains
d. Adequate pain relief with opiods
Answer: d
54. Find the CORRECT statement regarding laparoscopy.
a. To avoid injury to the deep inferior epigastric vessels, the lateral trocar should be placed 3 to 4 cm medial to the medial umbilical ligament
b. Transillumination of the abdominal wall from within permits the identification of the deep inferior epigastric vessels in most thin women
c. The amount of gas transmitted into the peritoneal cavity should depend on the measured intraperitoneal pressure, not the volume of gas inflated
d. Hasson’s open entry method is better than the closed method in preventing organ injury
Answer: c
55. Find the FALSE statement.
a. Data are insufficient regarding fasting times for clear liquids and the risk of pulmonary aspiration during labor
b. Modest amounts of clear liquids can be allowed in uncomplicated laboring women
c. Obvious solid foods are best avoided
d. A fasting period of 6 to 8 hours for solid food is recommended for uncomplicated parturients prior to undergoing Category I, II and III Caesarean sections
Answer: d
56. Findings consistent with an Acute Peripartum or intrapartum event leading to Hypoxic-Ischemic Encephalopathy are the following EXCEPT
a. Apgar score < 5 at 5 and 10 minutes
b. Umbilical arterial pH < 7.0 and/or base deficit > 12 mmo I/L
c. Sentinel hypoxic or ischemic event occurring immediately before or during delivery
d. Spastic diplegia and ataxia type cerebral palsy
Answer: d
57. Absolute contraindications to External Cephalic Version in Breech include all EXCEPT
a. Oligohydramnios
b. Antepartum hemorrhage
c. Any contraindication to labour
d. Multiple gestation
Answer: a
58. Which of the following is used to deliver an arrested after coming head in assisted breech delivery of chin to pubis rotated baby ?
a. Scanzoni maneuver
b. Pajot’s maneuver
c. Prague maneuver
d. Kristellar maneuver
Answer: c
59. Which is NOT a contraindication to vacuum extraction ?
a. Brow presentation
b. Fetal bleeding disorder or demineralization disorder
c. Previous fetal scalp sampling
d. Less than 34 weeks of gestation
Answer: c
60. All the following are TRUE EXCEPT
a. Third-and fourth-degree lacerations at delivery are associated with an increased risk of fecal incontinence (OR 2-3)
b. Patients with occult anal sphincter tears are 8 times more likely to have fecal incontinence
c. There is sufficient evidence to support primary elective cesarean delivery for the purpose of preserving fecal continence
d. Both forceps and vacuum-assisted vaginal delivery significantly increase this risk, with vacuum being less traumatic than forceps
Answer: c
61. All the following are TRUE statement about gonadal differentiation EXCEPT
a. It now appears that both testis and ovary differentiation require dominantly acting genes
b. SRY activation of SOX 9 may be all that is necessary to activate other genes important to testis development
c. WNT4 and R-Spondin 1(RSPO1) genes team to promote ovary development via repression of SOX9
d. Ovarian differentiation is considered the “default” pathway of sexdetermination the automatic result in the absence of a testis-determining factor
Answer: d
62. All are TRUE statements about Complete Androgen Insensitivity EXCEPT
a. One in three phenotypic sisters of an affected individual may have an XY karyotype but 40% may not have a family history
b. The normal testes produce normal amounts of AMH and testosterone and absent spermatogenesis, serum LH levels are increased and the serum FSH usually is in the normal range
c. They present with primary amenorrhea, normal breast development, absent or scant pubic and axillary hair, a short vagina and an absent cervix and uterus
d. Gonadectomy generally is best done before puberty because the overall risk for tumor development is 30%
Answer: d
63. The FALSE statement regarding Congenital Adrenal Hyperplasia is
a. An females, the classic forms of CAH (with and without salt wasting) are characterized by genital ambiguity and is most commonly due to 21-hydroxylase deficiency
b. Two-thirds of patients with 11β-hydroxylase deficiency exhibit hypotension and hypokalemia
c. Females with the non-classical “late-onset” form of 21-hydroxlyased deficiency have normal external genitalia and present later, during early adolescence with precocious puberty or other signs of hyperandrogenism such as hirsutism
d. Diagnosis of 21-hydroxylase deficiency is based on a high serum concentration of 17-OH Progesterone
Answer: b
64. The FALSE statement about Puberty in humans is
a. “diphasic” pattern of gonadotropin secretion from infancy to puberty results primarily from a high sensitivity to low levels of gonadal steroid feedback
b. central GABA signaling is one of the factors that restrains GnRH neuronal activity during childhood
c. glutamate signaling may play a role in the resurgence of pulsatile GnRH secretion at the onset of puberty
d. hypothalamic kisspeptin-GPR54 signaling is a key component of the neurobiologic mechanism that triggers the onset of puberty
Answer: a
65. All are TRUE regarding premature ovarian Insufficiency (POI) EXCEPT
a. In all patients under age 30 with a diagnosis of POI, a karyotype should be obtained
b. Women with POI should be offered testing for FMR1 premutations
c. Women with POI should be screened for antiadrenal antibodies and for antithyroid antibodies
d. Likelihood of achieving pregnancy after diagnosis of POI is about 60-80% and donor eggs are rarely required for IVF
Answer: d
66. The FALSE statement regarding PolyCystic Ovarian Syndrome (PCOS) is
a. AMH production is increased severalfold in anovulatory PCOS
b. Those with PCOS generally exhibit altered GnRH pulse frequency, increased serum LH concentrations and low-normal FSH levels
c. Insulin acts synergistically with LH to perpetuate ovarian androgen production and also inhibits hepatic SHBG production
d. Insulin resistance due to obesity also causes increased leptinsignalling and increased adiponectin levels, there by decreasing fatty acid oxidation and promoting lipotoxicity
Answer: d
67. Identify the FALSE statement about Metformin
a. Metformin increases insulin sensitivity up to 20% and decreases fasting glucose by about 5%
b. Metformin decreases weight and BMI by 3-5%
c. Metformin has no effect on lipolysis and HDL cholesterol
d. Metformin improves the chronic inflammatory state in women with hyperinsulinemia
Answer: c
68. All statements regarding Familial cancers are TRUE EXCEPT
a. about 15-20% of women who develop ovarian cancer have mutations in BRCA1 gene
b. Prophylacticsalpingo-oophorectomy reduces the risk of ovarian cancer by about 90% and the risk of breast cancer by about 50%
c. Risk-reducing salpingo-oophorectomy is recommended at age 35 or when childbearing is complete for patients carrying BRCA1 mutations and by age 40 in BRCA2 carriers
d. The use of combined oral contraceptives is likely to reduce the risk of ovarian cancer, but the effect on breast cancer risk is uncertain
Answer: a
69. All are TRUE about Tamoxifen EXCEPT
a. Tamoxifen is selective estrogen receptor modulator, having both estrogen receptorantagonist and agonist properties, depending on the tissue
b. The incidence of endometrial cancer quadrupled with 5 years of tamoxifen treatment
c. Levonorgestrel intrauterine device (IUD) is not effective to protect the endometrium against hyperplasia and polyps in women using tamoxifen
d. Tamoxifen is associated with an ultrasonographic image that is characterized by sonolucent changes that are subepithelial in the presence of atrophic epithelium
Answer: c
70. Identify the FALSE statement about Endometrial Hyperplasia
a. Lesions without atypia basically represent only exaggerated forms of persistent proliferative endometrium and are associated with little risk (1-3%) for progression to adenocarcinoma
b. Atypical endometrial hyperplasia does not often spontaneously regress and has significant risk (10-30%) of progression to adenocarcinoma if left untreated
c. There is significant risk (upto 40%) of an unrecognized adenocarcinoma in endometrial hyperplasia with atypia
d. Biopsy is not indicated when the clinical history suggests long-term unopposed estrogen exposure but the endometrial thickness is 5-12 mm
Answer: d
71. Find the FALSE statement regarding HPV induced CIN.
a. HPV-16 infection is a very specific finding and can be found in only 2% of women with normal cervical cytology
b. HPV-18 is more specific than HPV-16 for invasive tumors
c. Metaplasia found at the squamocolumnar junction, begins in the subcolumnar reserve cells
d. As the CIN lesions become more severe, the HPV copy numbers decrease, and the capsid antigen disappears
Answer: a
72. The sensitivity of cervical cytology testing by Pap Smear for the detection of CIN 2 or 3 ranges from
a. 60 to 95%
b. 47% to 62%
c. 20-30%
d. 10-15%
Answer: b
73. Cervical conisation is indicated in all EXCEPT
a. ECC histologic findings are positive for CIN 2 or CIN 3
b. Lack of correlation between cytology, biopsy and colposcopy
c. Type I transformation zone
d. Diagnosis of AGC-AIS
Answer: c
74. The following drugs are approved for treatment of Genitourinary Syndrome of Menopause (GSM) EXCEPT
a. Ospemifene
b. 17 beta oestradiol
c. Paroxetine
d. DHEA
Answer: c
75. Following are the duties of a Registered Medical Practitioner under POCSO Act of India EXCEPT
a. The registered medical practitioner shall submit the report on the condition of the child within 48 hrs to the SJPU or local police
b. Provide prophylaxis for identified STD including prophylaxis for HIV and emergency contraception
c. Shall request for legal or magisterial requisition or other documentation prior to rendering such care
d. Options 1) and 3)
Answer: d
76. Using WHO classification for Semen Analysis interpretation, choose the FALSE statement is
a. The normal lower limit for normal morphology is 4%
b. The normal lower limit for sperm motility is 32%
c. Viability should be at least 58%
d. The normal lower limit for sperm concentration is 39 million/mL
Answer: d
77. Contraindications to using Gonadotropins for ovulation induction in infertile women include all EXCEPT
a. Uncontrolled thyroid and adrenal dysfunction
b. Hypogonadotropichypogonadism due to space occupying lesions
c. Sex hormone-dependent tumors of the reproductive tract and accecssory organs
d. Kallmann syndrome
Answer: d
78. All the following are methods to decrease OHSS EXCEPT
a. HCG trigger
b. GnRH antagonists
c. Invitro oocyte maturation
d. Cabergoline
Answer: a
79. All statements about heterotopic pregnancy are TRUE EXCEPT
a. 1 in 30000 in spontaneous conceptions, as high as 1% with IVF treatment
b. Only 26% of heterotopic cases can be diagnosed with transvaginal US
c. Most often diagnosed in the first 5 to 8 weeks of gestation
d. After treatment of a heterotopic gestation, the overall delivery rate for the intrauterine pregnancy is only 10-20%
Answer: d
80. All the following are independent prognostic variables in endometrial cancer EXCEPT
a. Myometrial invasion
b. Peritoneal cytology
c. Tumor size
d. Lymph node metastasis
Answer: b
81. Find the INCORRECT statement regarding endometrial cancer.
a. Inactivation of the PTEN tumor-suppressor gene is the most common genetic defect in type I cancers
b. Type I cancers arise from its precursor Endometrial Intraepithelial Carcinoma (EIC)
c. Type II cancers frequently demonstrate alterations in HER2/neu,p53,p16,E-cadherin and loss of LOH
d. Type II endometrial cancer appears to be unrelated to high estrogen levels and often develops in nonobese women
Answer: b
82. All are TRUE regarding Leiomyosarcoma EXCEPT
a. This malignancy has no relationship with parity
b. A history of prior pelvic radiation can be elicited in about 50% of women with uterine LMS
c. Surgery is the mainstay of treatment for uterine LMS
d. Retroperitoneal lymphatic spread is rare in women with early-stage disease and lymphadenectomy is not associated with a survival advantage
Answer: b
83. All the following are TRUE about TTTS EXCEPT
a. Although growth discordance or growth restriction may be found with TTTS, these per se are not considered diagnostic criteria
b. TTTS is diagnosed in a monochorionicdiamnionic pregnancy when there is oligamnios SVP<2 cm in one sac and polyhydramnios SVP>8 in the other sac
c. Sonography surveillance of pregnancies at risk for TTTS should begin at 16 weeks and continue every 2 weeks
d. The discrepancies in amnionic fluid volumes of TTTS are also typically seen in Twin Anaemia Polycythemia Sequence (TAPS)
Answer: d
84. Find the FALSE statement regarding 2018 FIGO staging of cancer cervix.
a. Tumour of size ≥ 2 cm and < 4 cm confined to the cervix is stage IB2
b. Imaging and pathology can be used, where available, to supplement clinical findings with respect to tumor size and extent, in all stages
c. The involvement of lymph nodes are not part of staging
d. The lateral extent of the lesion is no longer considered
Answer: c
85. The boundaries of paravesical space include all EXCEPT
a. The obliterated umbilical artery running along the bladder medially
b. The obturator internus muscle along the pelvic sidewall laterally
c. The uterosacral ligament posteriorly
d. The pubic symphysis anteriorly
Answer: c
86. All are TRUE about antiphospholipid antibody syndrome EXCEPT
a. Asherson syndrome is a rapidly progressive thromboembolic disorder due to a cytokine storm seen in antiphospolipid antibody syndrome
b. Approximately 60 percent of patients with APS have a positive lupus anticoagulant LAC assay alone
c. Heparin binds to beta 2 glycoprotein I and prevents binding of anticardiolipin andanti-beta 2 glycoprotein I antibodies to the syncytiotrophoblasts
d. Treatment using aspirin, anticoagulation and close monitoring has increased live birth rates to more than 70 percent in women with APS
Answer: b
87. All are TRUE about management of obstetric haemorrhage EXCEPT
a. The most important mechanism of action with internal iliac artery ligation is an 85-percent reduction in pulse pressure in those arteries distal to the ligation
b. ROTEM or TEG cannot diagnose coagulopathies stemming from platelet dysfunction or anti platelet drugs
c. Each single-donor apheresis six-unit bag raises the platelet count by approximately 5000/L
d. Dilutional coagulopathy that is clinically indistinguishable from DIC is the most frequent coagulation defect found with blood loss and multiple transfusions
Answer: c
88. All are TRUE about USS features of Placenta Accreta Spectrum (PAS) EXCEPT
a. loss of the normal hypoechoicretroplacentalzone between the placenta and uterus
b. placental vascular lacunae or lakes
c. distance between the uterine serosa-bladder wall interface and the retroplacental vessels measures < 10 mm
d. placental bulging into the posterior bladder wall
Answer: c
89. USS has a sensitivity of ____________ in suspected abruptio placenta.
a. 24%
b. 54%
c. 81%
d. 93%
Answer: a
90. All are TRUE about COVID-19 in pregnancy EXCEPT
a. It is associated with an almost three times greater risk of preterm birth (17%)
b. Majority of pregnant women (74%) may be asymptomatic
c. ICU admissions are not more common in pregnant women compared to nonpregnant women of the same age
d. Risk factors associated with hospital admissions include older age, obesity, diabetes and hypertension
Answer: c
91. All are TRUE regarding Fetomaternal unit in pregnancy EXCEPT
a. Progesterone production by the placenta is largely independent of the quantity of precursor available, the utero-placental perfusion and fetal well-being
b. There is a 17 alpha hydroxylase enzyme block in the fetus and placenta has very little 3 beta hydroxyl steroid dehydrogenase activity
c. Cholesterol and pregnenolone are obtained mainly from the maternal bloodstream for placental progesterone synthesis
d. In human syncytiotrophoblast, estradiol increases progesterone production by means of an increase in LDL uptake
Answer: b
92. All are TRUE statements about Corpus luteum of Pregnancy EXCEPT
a. Progesterone is largely produced by the corpus luteum until about 10 weeks of gestation
b. Pulsatile luteinizing hormone (LH) and human chorionic gonadotropin (hCG) from the implanting pregnancy stimulate progesterone production by the corpus luteum
c. In the luteal phase of conception cycles, progesterone concentrations increase from about 1-2 mg/mL on the day of the LH surge to a plateau of approximately 10-35 mg/mL
d. The transitional luteo-placental shift takes place between the 10?ℎ week and 12?ℎ week
Answer: d
93. The FALSE statement regarding the glycoprotein hormone Human Chorionic Gonadotropin (HCG) is
a. A maximal level of about 100,000 IU/L in the maternal circulation is reached at 8-10 weeks of gestation
b. Long half-life of hCG (48 hours) is due mainly to the greater amino acid content of beta subunit
c. Hyperglycosylated hCG is the major circulating form of hCG regulating trophoblastic invasion in the first weeks of normal pregnancies
d. β-hCG can be detected in maternal blood about the eighth day after ovulation or one day after implantation
Answer: b
94. Find out the FALSE statement regarding human parturition
a. The initiating step in the sequence of events leading to parturition could bean increase in fetal ACTH and cortisol secretion and an increase in placental CRH
b. There is a definite decline in peripheral blood levels of progesterone prior to parturition and not just a functional withdrawal
c. An increase in estrogen levels in maternal blood begins at 34-35 weeks
d. The activity of 15-hydroxyprostaglandin dehydrogenase decreases in the myometrium and the chorion during labor and causes increase in prostaglandins associated with parturition
Answer: b
95. All the following statements about fetal lung surfactant are TRUE EXCEPT
a. Phosphatidylcholine (lecithin) and phosphatidylglycerol (PG) are present in only small concentrations until the last 5 weeks of pregnancy
b. At 20-22 weeks of pregnancy, a less stable and less active lecithin, palmitoyl-myristoyl lecithin, is formed
c. At about the 30?ℎ week of gestation, there is a sudden surge of dipalmitoyl lecithin, the major surfactant lecithin
d. The Sphingomyelin concentration of amniotic fluid changes relatively little throughout pregnancy and prior to 34 weeks, the Lecithin : Sphingomyelin L/S ratio is approximately 1 : 1
Answer: c
96. STRAW stage-3a is characterized by
a. menstrual cycles are relatively unchanged, the serum levels of FSH are low, AMH and inhibin B are low
b. menstrual cycles become shorter, FSH increases, while AMH, AFC and inhibin B declines
c. periods of amenorrhea lasting greater than or equal to 60 days, FSH level in menopausal range, vasomotor symptoms such as hot flushes
d. undetectable AMH, Inhibin and occasional antral follicle
Answer: b
97. The FALSE statement regarding Menopausal Hormone Therapy (MHT/HRT) is
a. Continuous, combined estrogen-progestin regimens of HRT has more risk for endometrial cancer than long-term sequential regimens
b. Ospemifene is given orally for the treatment of vulvar and vaginal atrophy
c. Bazedoxifene combined with conjugated estrogens is effective for hot flushes and vaginal atrophy, prevents bone loss and does not stimulate the endometrium or cause breast tenderness
d. The use of tibolone in women with a history of breast cancer remains relatively contraindicated
Answer: a
98. All the statements about Emergency Contraception are TRUE EXCEPT
a. Copper IUD can be used anytime during the preovulatory phase of the menstrual cycle and upto 8 days after ovulation
b. Ulipristal acetate is slightly more effective than the single 1.5-mg dose of levonorgestrel when used within 120 hours
c. Mifepristone prevents about 80-85% of expected pregnancies and has the same efficacy and side effects as levonorgestrel method
d. Treatment with Levonorgestrel acts primarily by preventing or delaying ovulation and by preventing fertilization
Answer: a
99. The FALSE statement about etonogestrel Implant (Nexplanon) is
a. Inhibits ovulation by preventing LH surge and failure rate is 0.01%
b. Implants have an immediate contraceptive effect when inserted within the first 7 days of a menstrual cycle
c. Implants should not be inserted immediate postpartum
d. It is absolutely contraindicated in women with active thromboembolic disease or known breast cancer
Answer: c
100. All the statements about reproductive ageing are TRUE EXCEPT
a. Age related Oocyte aneuploidy results primarily from premature separation of sister chromatids during meiosis I or from whole chromosome nondisjunction during meiosis II
b. Miscarriage riks and the prevalence of aneuploidy oocytes are relatively low and change little until approximately age 35
c. Live birth rates in donor egg IVF cycles relate to the age of the donor, not the age of the recipient
d. Aging itself is thought to be a significant factor influencing uterine endometrial response to steroids and receptivity
Answer: d