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 Test Information
Test Name SWTS-OBSTETRICS & GYNECOLOGY Total Questions 200

Test Type Examination Difficulty Level Difficult

Total Marks 600 Duration 120minutes

Test Question Language:- ENGLISH

(1). Placental anomalies are major contributors to obstetric haemorrhage. Which placental anomaly is shown in the image below?

a. Circumvallate placenta

b. Succenturiate placenta

c. Velamentous placenta

d. Furcate placenta

Solution. Ans-1: (b) Succenturiate placenta

Ref.: Read the text below
Sol :
Succenturiate placenta :
A small part of placenta is separated from the rest of the placenta.
Clinical importance is :
The accessory lobe may be retained in the uterus resulting in post partum hemorrhage and sepsis.
It is associated with placenta previa and vasa previa.
Circumvallate placenta
There is inward insertion of membranes from the edge towards the centre of the placenta (from deep implantation of the placenta
into the deciduas). Because of this excessive implantation, the placenta covers more than half of the fetal sac.
Unusually small chorionic plate with growth of extrachorial placental tissue
Complications of circumvallate placenta; antepartum hemorrhage, IUGR, pre-term labour.

Correct Answer. b

(2). The following changes occur in the vascular system of the newborn after birth

a. The proximal parts of the umbilical arteries become the lateral umbilical ligaments

b. Anatomical closure of the ductus arteriosus occurs soon after birth

c. Anatomical closure of the foramen ovale occurs with onset of respiration

d. Ductus venosus become ligamentum venosum

Solution. Ans-2: (d) Ductus venosus become ligamentum venosum.

Ref.: Read the text below
Sol :
The proximal parts of the umbilical arteries remain open as superior vesical arteries.
Anatomical closure of the ductus arteriosus occurs at about 1-3 months.
Anatomic closure of foramen ovale occurs in about 1 year.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 2/97
(3). The following are related to internal rotation of the head

a. Rotation occurs mostly in the cervix

b. In majority rotation occurs in the pelvic floor

c. Rotation occurs commonly after crowning of the head

d. Rotation is earlier in primiparas than multiparas

Solution. Ans-3 : (b) In majority rotation occurs in the pelvic floor.

Ref.: Read the text below
Sol :
Internal rotation of the head predominantly occurs on the pelvic floor and less commonly in the cervix.
Rotation is earlier in multiparas than primiparas.

Correct Answer. b

(4). The following are the blood values following delivery

a. Immediately following delivery, there is increase blood volume

b. Cardiac output remains as in prelabour value soon following delivery

c. Fibrinogen level remains high up to 2nd week postpartum

d. There is leucopenia

Solution. Ans-4 : (c) Fibrinogen level remains high up to 2nd week postpartum
Ref.: Read the text below
Sol :
Immediately following delivery, there is slight decrease in blood volume and the cardiac output rises to about 60% above the prelabour
values.
There is leucocytosis.

Correct Answer. c

(5). Premature menopause occurs before the age of :

a. 40 years

b. 35 years

c. 45 years

d. 50 years

Solution. Ans-5 : (a) 40 years

Ref.: Read the text below
Sol :
The range for the age of menopause is 48-55 years age,about 1% women will experience menopause < 40 years especially those who
underwent abdominal hysterectomy followed by compromised ovarian vasculature.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 3/97
(6). All are true about oxytocin except:

a. Causes regular uterine

b. Octapeptide

c. Promotes development of lobules of beast

d. Has ADH-like action

Solution. Ans-6 : (c) Promotes development of lobules of beast

Ref.: Read the text below
Sol :
Oxytocin is an octapeptide, with ADH-like action in high doses antidiuresis; pulmonary edema can occur.
Oxytocin is responsible for milk ejection reflex i.e. contraction o the myoepithelial cells of mammary alveoli, which is initiated by
suckling (Galactokinesis).
While development of breast lobules is the process of mammogenesis occurring during the course of pregnancy, while prolactin is
responsible for Galactopoiesis which is the process of maintenance and continuous lactation, during suckling

Correct Answer. c

(7). In an uncomplicated twin pregnancy normal delivery should be attempted in the following situation :

a. First baby-vertex and second baby transverse lie

b. Both babies and breech presentation

c. First baby transverse lie and second longitudinal lie

d. First baby transverse lie and second frank breech

Solution. Ans-7 : (a) First baby-vertex and second baby transverse lie
Ref.: Read the text below
Sol :
The first baby vertex, and 2nd baby with malpresentation or abnormal lie, can be undertaken for vaginal delivery (in an unscarred
uterus, i.e. no history of previous cesarean section).
If the 2nd twin is persistently in tranverse lie (as per the option), following delivery of 1st twin, internal podalic version for the 2nd twin
(the only indication of the manoeuvre in modern obstetrics), can be done.
All other options are indications for cesarean section.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 4/97
(8). Which of the following is non-contraceptive benefits of the combined oral contraceptive pill

a. Decreased risk of colorectal cancer

b. Decreased risk of lung cancer

c. Decreased risk of breast cancer

d. Decreased risk of gall bladder disease

Solution. Ans:8 (a) Decreased risk of colorectal cancer

Ref:Read the text below
Sol:
Colorectal & Gynaecological tumours
COCP associated with a reduction in risk of colorectal cancer
Halving the risk of endometrial and ovarian cancers.
Reduced incidence of functional ovarian cysts and benign ovarian tumours
Reduction in risk of BENIGN breast disease.
Control of menstrual irregularities
Effective treatment for dysmenorrhoa (painful periods).
Effective treatment for menorrhagia: reduce menstrual blood flow by up to 43%
Lower incidence of anaemia in menstruating women because of reduction in blood flow
Some benefits in women with pre menstrual tension.
Reduction in risk of ectopic pregnancy - all forms of contraception reduce risk of ectopic.
Acne: improves skin conditions
PID conflicting data but it may reduce risk of acute PID

Correct Answer. a

(9). Which of the following combinations of maternal, paternal, and fetal red blood cell (RBC) antigens places the pregnant woman at risk for
isoimmunization?

Maternal Paternal Fetal

a. Positive Positive Positive
b. Positive Negative Positive
c. Positive Negative Negative
d. Negative Positive Positive

a. a

b. b

c. c

d. d

Solution. Ans-9: (d) Negative Positive Positive

Ref:Read the text below
Sol:
Isoimmunization occurs when the fetus has a paternally derived antigen for which the mother is negative.
This situation allows the mother to make antibodies against the fetal antigen; these antibodies can then cross the placenta and
hemolyze the fetal red blood cells (RBCs).

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 5/97
(10). A primigravida has delivered her baby one hour ago but has not yet delivered the placenta and is bleeding. The management of choice
should be:

a. Hysterectomy

b. Uterine massage

c. Removal of placenta under GA

d. Administer concentrated syntocinon

Solution. Ans-10: (c) Removal of placenta under GA

Ref:Read the text below
Sol:
This is retained placenta.and treatment is removal under GA.
Failure of placental delivery within 60 minutes after delivery of the fetus.
Management
If the placenta is undelivered after 30 minutes consider:
Emptying bladder
Breastfeeding or nipple stimulation
Change of position - encourage an upright position

Correct Answer. c

(11). Which of the following is not an imminent indication for termination of pregnancy in a woman with preeclampsia?

a. A woman at 35+4 weeks POG with a BP 160/108 and biophysical profile 6/10

b. 34 weeks POG with absent end diastolic flow on Doppler and BP 150/100 on antihypertensives

c. 36 weeks with Bp= 180/94 complaining of pain abdomen, tender uterus on clinical examination and presence of vaginal bleeding.

d. None

Solution. Ans-11: (b) 34 weeks POG with absent end diastolic flow on Doppler and BP 150/100 on antihypertensives.
Ref:Read the text below
Sol:
Indications for termination in case of preeclampsia
Maternal Fetal
Progressive detoriation of renal/hepatic functn with BP>160/110 Suspected abruption placenta
Eclampsia Severe IUGR with Reversed end diastolic flow
Gestational age >34 weeks if BP not controlled on multiple
Non reassuring NST/biophysical profile
antihypertensives and urine alb is progressively increasing
Impending eclampsia Severe oligohydraMNIOS/ABSENT LIQUOR

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 6/97
(12). Ureteric constriction is seen at all the following positions, except:

a. Ureteropelvic junction

b. Ureterovesicle junction

c. Crossing of iliac artery

d. Ischial spine

Solution. Ans-12: (d) Ischial spine

Ref:Read the text below
Sol:
The normal ureter is not of uniform caliber, with three distinct narrowingsclassically described: the ureteropelvic junction, crossing of
the iliac vessels, and the ureterovesical junction.
Sites of narrowing of the normal ureter are:
Ureteropelvic junction: At the ureteropelvic junction, the renal pelvis tapers into the proximal ureter. In many cases, this perceived
narrowing may be more apparent than real, with no evidence of obstruction evident on radiographic or endoscopic investigation.
Crossing of the iliac vessels: Due to a combination of extrinsic compression of the ureter by the iliac vessels and the necessary
anterior angulation of the ureter as it crosses the iliac vessels to enter into the pelvis. There is also no intrinsic change in the ureteral
caliber at this location.
Ureterovesical junction: A true physical restriction of the ureter as it makes the intramural passage through the bladder wall to the
ureteral orifice.
Juxtaposition of the vas deferens or broad ligament
Ureteric orifice

Correct Answer. d

(13). Which of the following is true regarding gastrulation:

a. Establishes all the three germ layers

b. Occurs at the caudal end of the embryo prior to its cephalic end

c. Involves the hypoblastic cells of the inner cell mass

d. Usually occurs at 4 weeks

Solution. Ans-13: (a) Establishes all the three germ layers

Ref:Read the text below
Sol:
Establishes all the three germ layers.
Gastrulation is the process that establishes all the 3 germ layers in the embryo.
Gastrulation is the most characteristic event occurring during the 3rd week and not the 4th week
The embryonic epiblast undergoes gastrulation. It does not involve the hypoblastic cells of the inner cell mass.
Occurs at the cephalic end prior to the caudal end.

Correct Answer. a

(14). Which of the following is true about multiple pregnancy

a. Same sex rules out dichorionicity

b. Twin peak sign is seen in dichorionicity

c. Thick separating membrane is present in monochorionic twins

d. Best detected after 16 weeks of gestation

Solution. Ans-14: (b) Twin peak sign is seen in dichorionicity

Ref:Read the text below
Sol:
The twin peak sign refers to a triangular projection of placental tissue extending from the placental surface, insinuating itself
between the layers of the intertwin membrane, and seen on ultrasonographic (US) studies of multiple gestations.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 7/97
(15). HCG is secreted by :

a. Amniotic membrane

b. Yolk sac

c. Decidua

d. Trophoblast cells

Solution. Ans-15: (d) Trophoblast cells

Ref.: Read the text below
Sol :
HCG
Glycoprotein synthesized by syncytiotrophoblast of the placenta
It has 2 subunits; alpha (non specific, similar to LSH, FSH, LH) and beta (specific)
It can be detected in maternal serum 8 days following ovulation by immunoassay
Half life of HCG is 24-36 hours
Most sensitive test to detect hCG is Radioimmunoassay (RIA)
In early pregnancy, doubling time of hCG in plasma is 2 days
Very high levels of HCG are seen in : multiple pregnancies, hydatidiform mole, Downs syndrome

Correct Answer. d

(16). What is the most common cause of obstetric death?

a. Hemorrhage

b. Cardiac disease

c. Anemia

d. Gestational hypertension

Solution. Ans-16: (a) Hemorrhage

Ref.: Read the text below
Sol :
Hemorrhage is the single most important cause of maternal death worldwide obstetrical hemorrhage accounts for almost half of all
postpartum deaths in developing countries

Correct Answer. a

(17). Which of the following hormones increase after menopause?

a. Estrogen

b. Progesterone

c. FSH

d. Inhibin

Solution.
Ans-17: (c) FSH
Ref.: Read the text below
Sol :
Cessation of ovarian activity and a fall in inhibin level, cause a rebound increase in secretion of FSH and LH by the anterior pituitary.
FSH may rise as much as 50 fold and LH by 3-4 fold.
Estrogen fall by 66% and the main estrogen of menopause is estrone, derived from the peripheral conversion of androstenedione
secreted by the ovary.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 8/97
(18). The result of which the following tests is most likely to be inaccurate as a result of bacterial vaginosis.

a. Nitrazine test

b. Fern test

c. Transabdominal instillation of methylene blue

d. Pooling of amniotic fluid in speculum exam

Solution. Ans-18: (a) Nitrazine test

Ref: Read the text below
Sol :
The amniotic fluid or vaginal discharge is tested with nitrazine paper which will turn dark blue in the presence of an alkaline pH.
Hence, bacterial vaginosis, which also results in an alkaline vaginal discharge can yield a false positive result.
A more definitive test is the presence of ferning n an air-dried slide. The most definitive test is transabdominal instillation of indigo-
carmine dye. A tampon is then inserted into the vagina and later inspected for discoloration.)

Correct Answer. a

(19). After the B-hCG titer becomes undetectable, the patient treated for hydatidiform mole should be followed with monthly titers for a period
of

a. 6 months

b. 1 year

c. 2 years

d. 5 years

Solution. Ans-19: (b) 1 year

Ref: Read the text below
Sol :
Following evacuation, B-hCG titers are followed weekly and should be undetectable by 12-16 weeks. This will depend partly on the
initial peak level as well as renal blood flow and amount of residual trophoblastic tissue.
The titer should be followed monthly for one year after hCG is undetectable and hence, it is imperative that the patient should use a
reliable form of birth control.

Correct Answer. b

(20). The following are related to puerperal state except

a. In non-lactating mothers, ovulation may occur as early as 36-42 days.

b. Ovulation may precede the first menstrual period following delivery

c. Colostrum has got high sugar and fat, compared to breast milk

d. For lactation suppression, drugs should be avoided.

Solution. Ans-20: (c) Colostrum has got high sugar and fat, compared to breast milk.
Ref.: Read the text below
Sol :
Colostrum has got low carbohydrate and fat but more protein and minerals compared to breast milk.
Due to the reported side effects of drugs (bromocriptine or oestrogen or androgen), milk is left to dry up naturally.
Analgesics are useful.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 9/97
(21). The advantage of hysterectomy in molar pregnancy is

a. Chance of choriocarcinoma becomes nil

b. Follow up is not required

c. Enlarged ovaries can be removed during operation

d. Chance of pulmonary embolisation is minimal

Solution. Ans-21: (d) Chance of pulmonary embolisation is minimal.

Ref.: Read the text below
Sol :
Chance of choriocarcinoma may be reduced significantly but cannot be brought down to nil.
Follow up is mandatory and the lutein cyst should not be removed as a routine during surgery.
Chance of pulmonary embolisation is minimal

Correct Answer. d

(22). Prophylactic chemotherapy in hydatidiform mole should preferably be given

a. Prior to evacuation as a routine

b. Following evacuation as a routine

c. Selected cases following evacuation

d. As a routine 6 weeks post evacuation

Solution. Ans-22: (c) Selected cases following evacuation

Ref.: Read the text below
Sol :
Cytotoxic drugs are hazardous and often prove fatal.
However, in high risk patient specially where facilities for follow up are not available, prophylactic chemotherapy has got a place
following evacuation of mole.

Correct Answer. c

(23). A 25 year old woman with secondary infertility from tubal obstruction presents with a 3 days history of nausea, vomiting and abdominal
pain following ovulation induction with gonadotropins. Her urine pregnancy test is negative. Which of The following is most probable
diagnosis

a. Ectopic pregnancy

b. Ovarian hyperstimulation syndrome

c. Premenstrual syndrome

d. Deep vein thrombosis

Solution. Ans:23 (b) Ovarian hyperstimulation syndrome

Ref:Read the text below
Sol:
Most likely diagnosis is OHSS
Differential diagnosis of OHSS
Infection PID, appendicitis
Pregnancy related Ectopic pregnancy
Complication of Ovarian cyst torsion, haemorrhage , Intra-abdominal haemorrhage

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 10/97
(24). The following types of urogenital prolapse are paired with effective surgical treatments except

a. Uterine prolapse vaginal hysterectomy

b. Anterior wall prolapse (cystocele) colposuspension

c. Vaginal vault prolapse sacro-spinous fixation

d. Posterior wall prolapse (rectocele) posterior colporrhaphy

Solution. Ans:24 (b) Anterior wall prolapse (cystocele) colposuspension

Ref:Read the text below
Sol:
Surgery for urogenital prolapse
1) Vaginal hysterectomy is the operation of choice for uterine prolapse
2) Anterior repair (colporrhaphy) is the operation of choice for anterior vaginal wall prolapse
3) Posterior repair (colporrhaphy) is the operation of choice for posterior vaginal wall prolapse
4) Usually, vaginal hysterectomy is accompanied by anterior / posterior repair
5) Abdominal sacro-colpopexy is used for vaginal vault prolapse. The vault is suspended from the anterior longitudinal ligament which
runs in front of the sacrum.
6) Sacro-spinous fixation is used for vaginal vault prolapse suspends the vaginal vault from the sacro-spinous ligament. This operation
is performed through the vagina.

Correct Answer. b

(25). Ideal time for blood sugar screening for diabetes in a pregnant female is :-

a. 24-28 weeks

b. 28-36 weeks

c. 36 weeks

d. 1st trimester

Solution. Ans-25: (a) 24-28 weeks

Ref: Read the text below
Sol:
The guidelines which are usually followed regarding screening for diabetes :
For high risk cases Screening should be done as soon as possible.
For average risk cases Screening done at 24-28 weeks.
For low risk cases blood glucose testing not routinely required.
"Screening for gestational diabetes should be performed between 24-28 weeks in those women not known to have glucose intolerance
in their earlier pregnancy".

Correct Answer. a

(26). Which is first sign of intrauterine death :-

a. Intra-aortic gas

b. Increased curvature of spine

c. Spalding sign

d. Shrinking body

Solution. Ans-26: (a) Intra-aortic gas

Ref: Read the text below
Sol:
Earliest sign to appear in case of intrauterine fetal death is appearance of gas shadow (Robert's sign) in great vessels and chambers
of the heart. It appears as early as 12 hours.
X-ray signs in IUD :
Spalding Sign : Irregular overlapping of cranial bones on another seen in X-ray is called spalding sign. It appears 7 days after death.
Hyper flexion of spine
Crowding of the rib shadows

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 11/97
(27). Bluish suburethral nodule seen in lower one-third of vagina is suggestive of :

a. Choriocarcinoma

b. Carcinoma vagina

c. Carcinoma cervix

d. Carcinoma vulva

Solution. Ans-27: (a) Choriocarcinoma

Ref: Read the text below.
Sol:
The majority of primary growths arise in the body of the uterus and develop first within the endometrial cavity.
Choriocarcinoma always infiltrates the wall of the uterus.
Metastasis early and disseminated ; usually occurs by the way of bloodstream.
Metastases which can detected easily are those found in lower third of vagina and at vulva.
Such metastasis form purple hemorrhagic projections either into the vagina or around the vaginal orifice.
Their appearance is characteristic and pathognomic.
On examination, a vaginal metastasis appears as bluish red vascular tumor which bleeds easily on touch.

Correct Answer. a

(28). For medical abortion following drug is effective:-

a. Oral methotrexate

b. Oral mifepristone alone

c. Combination of oral mifepristone with vaginal misoprost

d. Vaginal mifepristone alone

Solution. Ans-28: (c) Combination of oral mifepristone with vaginal misoprost

Ref: Read the text below
Sol:
Most effective regime is oral mifepristone (600mg single dose) followed by vaginal misoprost (800mg), 72 hours after the oral dose
of mifepristone.
The success rate is 97% with complete expulsion of conceptus.
Regime is ideal upto 45 days of amenorrhea.

Correct Answer. c

(29). The most common manifestation of androgen excess in women is-

a. Coarsening of voice

b. Hypertrichosis

c. Hirsutism

d. Loss of female body contour

Solution. Ans-29: (c) Hirsutism

Ref: Read the text below
Sol:
Hirsutism is the most frequent manifestation of androgen excess in women.
Hypertrichosis is a term reserved for androgen independent growth of hair that is prominent in non-sexual areas.
Coarsening of voice, loss of female body contour, male pattern baldness, decrease in breast size, increase in muscle mass and
clitomegaly are features of virilization, are less common manifestation of androgen excess than hirsutism.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 12/97
(30). Expected date of delivery (EDD) is arbitrary. Which of the following is the most incorrect statement regarding EDD?

a. Less than 5% of women deliver on the exact date which is 40 weeks of gestation

b. The standard deviation of EDD is 3 weeks around the expected due date or at term

c. 80% of females deliver within 2 weeks of EDD

d. 50% of females deliver within 1 week of this period

Solution. Ans-30: (b) The standard deviation of EDD is 3 weeks around the expected due date or at term
Ref: http://en.wikipedia.org/wiki/Pregnancy#Determining_gestational_age
Sol:
As measured on a reference group of women with a menstrual cycle of exactly 28-days prior to pregnancy, and who had spontaneous
onset of labor, the mean pregnancy length has been estimated to be 283.4 days of gestational age as timed from the first day of the last
menstrual period as recalled by the mother, and 280.6 days when the gestational age was retrospectively estimated by obstetric
ultrasound measurement of the fetal biparietal diameter (BPD) in the second trimester.
Other algorithms take into account a variety of other variables, such as whether this is the first or subsequent child (i.e., pregnant
woman is a primipara or a multipara, respectively), the mother's race, parental age, length of menstrual cycle, and menstrual regularity),
but these are rarely used by healthcare professionals.
In order to have a standard reference point, the normal pregnancy duration is generally assumed to be 280 days (or 40 weeks) of
gestational age.
The best method of determining gestational age is ultrasound during the first trimester of pregnancy.
This is typically accurate within seven days.
This means that fewer than 5 percent of births occur on the day of being 40 weeks of gestational age (option 1); 50 percent of
births are within a week of this duration (option 4), and about 80 percent are within 2 weeks (option 3).
Once the estimated due date (EDD) is established, it should rarely be changed, as the determination of gestational age is most
accurate earlier in the pregnancy.
The most common system used among healthcare professionals is Naegele's rule, which was developed in the early 19th century.
This calculates the expected due date from the first day of the last normal menstrual period (LMP or LNMP) regardless of factors
known to make this inaccurate, such as a shorter or longer menstrual cycle length.
Pregnancy most commonly lasts for 40 weeks according to this LNMP-based method, assuming that the woman has a predictable
menstrual cycle length of close to 28 days and conceives on the 14th day of that cycle.
As measured from the day of ovulation, the average time to birth has been estimated to be 268 days (38 weeks and two days), with a
coefficient of variation of 3.7%.

Correct Answer. b

(31). Menorrhagia is a common side effect seen in :

a. OC pills

b. Triphasic pills

c. Monophasic pills

d. Progestasert

Solution. Ans-31: (d) Progestasert

Ref.: Read the text below
Sol :
Menorrhagia is defined as cyclic bleeding at normal intervals; the bleeding is either excessive in amount (80 ml) or duration or both.
The term menotaxis is often used to denote prolonged bleeding.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 13/97
(32). Regarding toxoplasma all are true except :

a. IgM seen in 80%

b. Infection 75% if in 1st trimester

c. 65% damage if in 1st trimester

d. Perinatal mortality 5-10%

Solution. Ans-32: (b) Infection 75% if in 1st trimester

Ref.: Read the text below
Sol :
Toxoplasma gondii is a common protozoan parasite that can be found in humans and domestic animals.
Transmission is more common when the disease is acquired in the third trimester, although neonatal manifestations are usually mild or
sub clinical.
Infections acquired in the first trimester are transmitted less commonly; however, the infection has much more serious consequences
in the fetus.
Toxoplasmosis in pregnancy can be diagnosed maternally with IgM and IgG titers.
Diagnosis may influence the decision of whether to terminate a pregnancy in the first two trimesters.
The disease can be treated with pyrimethamine and a sulfonamide after 14 weeks gestation or spiramycin.
Spiramycin is preferable in pregnant women because no teratogenic effects are known

Correct Answer. b

(33). Cephalhematoma all are true except :

a. Appears few hrs after delivery

b. No surgical intervention required

c. Exterior to pericranium

d. Needle aspiration is contraindicated

Solution. Ans-33: (c) Exterior to pericranium

Ref.: Read the text below
Sol :
May not appear at birth, but develops a few hours even two of three days after delivery.
Is sharply limited by the sutures to a particular bone, the swelling being underneath the pericranium.
Swelling is soft and elastic; does not pit on pressure.
Gradually increases in size for sometime and takes weeks or even months to disappear.
In a case of cephalhematoma, it is advisable to treat it one expectant lines. Although it may take a long time, sometimes months,
before the swelling disappears, it is not desirable to incise it, as the chances of subsequent infection are great.

Correct Answer. c

(34). The quantity of amniotic fluid increases during full term amniotic cavity due to :

a. Urine from fetus

b. Mothers urine

c. Placenta

d. Umbilical vein

Solution. Ans-34: (a) Urine from fetus

Ref.: Read the text below
Sol :
Origin of Amniotic Fluid
The precise origin of the liquor amnii still remains unsolved. It is probably of mixed maternal and fetal origin. The following are the
speculative theories :
As a transudate from the maternal serum across the fetal membranes of from maternal circulation in the placenta.
As a transudate across the umbilical cord or from fetal circulation in the placenta or secretion from the amniotic epithelium.
Contribution from the fetal urine the fetus drinks about 400 ml of liquor every day at term and equal amount is excreted in the urine
if either ingestion or micturation is seriously interfered with, gross alteration of the volume occurs.
Secretion from the trachea-bronchial tree and across the fetal skin before the skin becomes keratinized at 20th week.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 14/97
(35). A 40-year-old lady comes with history of passing brownish foulsmelling vaginal discharge and hemoptysis. She give past history of
recurrent abortions. Chest X-ray is highly informative. Probable diagnosis is :

a. CA Endometrium

b. Chorio CA with lung secondary

c. Missed abortion

d. Genital TB

Solution. Ans-35: (b) Chorio CA with lung secondary

Ref.: Read the text below
Sol :
Choriocarcinoma is a highly malignant tumor arising from the chorionic epithelium. It should be remembered that it is not a tumor or
the uterus which is secondarily involved.
The choriocarcinoma develops following molar pregnancy in 2-10 percent.
Patient profile : There is usually a history of molar pregnancy in recent past. Rarely, its relation with a term pregnancy, abortion or
ectopic pregnancy may be established.
GTN* after a non-molar pregnancy is always a choriocarinoma

Correct Answer. b

(36). Which f the following chemotherapeutic agents is most commonly used in the treatment of GTN?

a. Cyclophosphamide

b. Vincristine

c. Tamoxifen

d. Methotrexate

Solution. Ans-36: (d) Methotrexate

Ref: Read the text below
Sol :
The chemotherapy most often employed is either Methotrexate or actinomycin-D. For patients with poor prognostic features.
Multi-drug regimes are employed. The first regimen described was MAC, consisting of Methotrexate, actinomycin-D and
Cyclophosphamide.
A six-drug regimen has been used extensively, the modified Bagshaxe regimen consisting of MAC plus folinic acid and etoposide

Correct Answer. d

(37). The placenta which is associated with the highest perinatal morbidity and mortality is :

a. Monochorionic, diamnionic

b. Dichorionic, diamnionic

c. Monochorionic, monoamnionic

d. Monoamnionic, dichorionic

Solution. Ans-37: (c) Monochorionic, monoamnionic

Ref: Read the text below
Sol :
Determination of chorionicity and amnionicity is extremely important for a number of reasons.
It is apparent that monochorionic, monoamnionic as well as monochorionic, diamnionic placentas can only occur with monozygotic
twins.
The high fetal mortality rate with from prematurity and vascular anastomosis.
Vascular anastomosis can also occur with monochorionic, diamnionic placentation.)

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 15/97
(38). Dizygotic twin gestation is associated with an increased risk of all of the following except:

a. Pretem delivery

b. Intrauterine growth restriction

c. Preeclampsia

d. Chorioangioma

Solution. Ans-38: (d) Chorioangioma

Ref: Read the text below
Sol :
Twin-twin transfusion syndrome results from vascular anastomosis between the arterial circulations of one twin with the venous
circulation of the other.
For the most part, this is restricted to monochorial placentas. This results in an artriovenous shunt.
One fetus becomes the donor and the other becomes the recipient. The donor becomes anemic and growth retarded while the
recipient becomes polycythemic and may develop congestive heart failure. The associated perinatal mortality is high and may be as high
as 60-70%. In an extreme case, the donor twin becomes physically stuck as a result of severe oligohydramnios.
Neurologic damage in the surviving twin has been associated with the death of one twin. In the presence of vascular anastomoses.
This was originally thought to be the result of the result of the release of tissue thromboplastin into the circulation of the survivor with
resultant disseminated intravascular coagulation (DIC).
This has been cited as the cause of multicystic encephalomalacia. More recently, this has thought to result from hypovolemic shock
in the survivor.
Because there is evidence of damage to the surviving twin soon after death of one twin, it is ill-advised to perform immediate
delivery of the survivor.

Correct Answer. d

(39). Placental circulation established by day

a. 5

b. 12

c. 30

d. 40

Solution. Ans-39: (b) 12

Ref: Read the text below
Sol :
Uterine blood flow at term is 750ml/ min
This is 10% of cardiac output
Utero placental circulation 450-650 ml/ min this is 90% of uterine blood flow
Placental circulation established by day 12
Feta circulation day 21

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 16/97
(40). In diagnosing mullerian anomalies which of the following tools is most accurate

a. HSG

b. MRI

c. Saline infusion sonography

d. 2D transvaginal ultrasound

Solution. Ans-40 : (b) MRI

Ref: Read the text below
Sol :
Uterus is formed from mullerian duct fusion by 10 weeks of POG.
Most common anomalies are midline fusion anomalies
Are classified as
Class1 segmental hypoplasia or agenesis
Class2 unicornuate
Class 3 uterine didelphius
Class 4 bicornuate
Class 5 septate
Class6) arcuate
Class 7 DES exposed
Most common anomaly is bicornuate 39%
Then septate 24%
D/D of septate on HSG is bicornuate and they can be differentiated by MRI, Laproscopy and sonohysterography and 3D 4D USG best
being MRI

Correct Answer. b

(41). Which is the first USG sign of pregnancy?

a. Appearance of gestational sac

b. Appearance of fetal cardiac activity

c. Bagels sign

d. Double bubble sign

Solution. Ans-41: (a) Appearance of gestational sac

Ref.: Read the text below
Sol :
The first sign of an intrauterine pregnancy is the appearance of the gestational sac.
It is usually visualized from 31 days or 4 weeks of gestation using the transvaginal method, when it measures 2-3 mm in diameter. It
can be identified about a week later, ie. identified at 5-6 weeks of gestation, using the trans abdominal route.
Double decidual sac sign is the normal ultrasonographic appearance of intrauterine gestational sac.

Correct Answer. a

(42). Regarding medical termination of pregnancy

a. Misoprostol is an effective effective abortificient only when used orally

b. Unsucessful use of misoprostol for MTP may result in fetal malformation

c. Mifepristone is associated with the significant risk of fetal abnormality in the event of failure

d. Failed termination of pregnancy is overall 10% even when properly done

Solution. Ans-42: (b) Unsucessful use of misoprostol for MTP may result in fetal malformation
Ref.: Read the text below
Sol :
Misoprostol can be used for termination of pregnancy when used either orally or vaginally.
Unsuccessful use of misoprostol as an abortificient may result in abnormalities in the children born thereafter.
Moebius syndrome (paralysis of facial muscles), ectopia vesicae, limb defects and hydrocephalus have been reported.
Continuation of pregnancy due to failure of MTP is around 1%
Mifepristone has not been reported to have significant risk of fetal malformations

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 17/97
(43). Regarding ultrasonographic fetal biometry

a. Abdominal circumference (AC) is the least sensitive parameter for deterction of IUGR

b. In asymmetric IUGR head circumference/abdominal circumference (HC/AC) is reduced

c. Serial biparietal diameter (BPD) is the only important measurement in IUGR

d. AC indirectly reflects fetal liver size and glycogen storage

Solution. Ans-43 : (d) AC indirectly reflects fetal liver size and glycogen storage.
Ref.: Read the text below
Sol :
Abdominal circumference is the most sensitive parameter.
The HC/AC ratio is increased.
AC is reduced as the stored liver glycogen is depleted.
There is brain sparing effect to cause raised HC/AC.

Correct Answer. d

(44). Choose the incorrect statement regarding flow velocimetry of umbilical artery

a. Resistance index of 1.0 implies absent end-diastolic flow

b. Absent end-diastolic flow is not associated with any risk of fetal structural or chromosomal abnormatlity

c. Higher the pulsatility index, greater is the placental vascular resistance

d. It correlates well with the spiral artery count

Solution. Ans-44: (b) Absent end-diastolic flow is not associated with any risk of fetal structural or chromosomal abnormatlity
Ref.: Read the text below
Sol :
Umbilical artery wave forms correlated well with the spiral artery cunt.
Resistance index of 1.0 implies absent end-diastolic flow
Higher the pulsatility index, greater is the placental vascular resistance
It correlates well with the spiral artery count
Waves of trophoblasts invasion (at 10-12 weeks and again at 12-16 weeks) in the spiral artery upto radial artery causes fall in the
pulsality index in normal pregnancy.
There is funneling of the arteries which causes increased blood flow. Trophoblastic invasion is absent in pre-eclampsia.
Absent or reversed end diastolic flow carries increased risk of fetal structural (20%) and chromosomal (4%) abnormality.

Correct Answer. b

(45). Diagnosis of acute fatty liver of pregnancy is usually made by :

a. Ultrasonography

b. Computed tomography

c. Magnetic resonance imaging

d. Biochemical investigation

Solution. Ans-45: (d) Biochemical investigation

Ref: Read the text below.
Sol:
Acute fatty liver of pregnancy :
Histological changes hepatocytes with increased microvascular fat, fibrin deposits in hepatic sinusoids. May occur in late pregnancy
and may be associated with pre-eclampsia.
Lab investigations serum bilirubin > 170 ugmol/L (10 mg/dL).
PT prolonged.
DIC ( fibrinogen level, fibrin degradation product, thrombocytopenia).

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 18/97
(46). The cyst which arises from the remnants of mesonephric duct and lies in the anterolateral aspect of the vaginal wall is ?

a. Bartholins cyst

b. Inculsion cyst

c. Endometriotic cyst

d. Gartners duct cyst

Solution. Ans-46: (d) Gartners duct cyst

Ref: Harrisons Principles of Internal Medicine-858
Sol:
Bartholins cyst cystic swelling at junction of posterior one-third and anterior two-thirds of labium majus.
It is compound racemose gland and acini are lined by low columnar epithelium.
Gartners duct cyst Remnant of Wolfian duct, runs parallel and below to fallopian tube in mesosalpinx Downward by side of uterus
to the level of internal os where it passes into the tissue of the cervix then forward to reach the anterolateral aspect of vaginal wall and
hymen.

Correct Answer. d

(47). Breech presentation is common in the following conditions, except :

a. Subseptate uterus

b. Bicornuate uterus

c. Unicornuate uterus

d. Septate uterus

Solution. Ans-47: (a) Subseptate uterus

Ref: Dutta --375
Sol:
Etiology of breech presentation :
Maternal Multiparity, polyhydramnios, oligohydramnios, placenta praevia, pelvic tumours, congenital uterine abnormalities (septate,
bicornuate corneal implantation of placenta).
Fetal Prematurity (one of the most common), multiple pregnancy, fetal abnormalities, e.g. hydrocephalus and anencephaly Breech
with extended legs, short cord, relative or absolute, intrauterine fetal death. Trisomies 13, 18, 21 and myotonic dystrophy.

Correct Answer. a

(48). Following is not a causative factor in habitual abortion :-

a. Septate Uterus

b. Incompetent OS

c. SLE (Anti phospholipids antibodies)

d. Toxoplasma gondii

Solution. Ans-48: (d) Toxoplasma gondii

Ref: Read the text below
Sol:
Toxoplasma gondii burns itself out and is unlikely to cause repeated abortion

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 19/97
(49). Which of the following infections does not cause an early abortion ?

a. Toxoplasmosis

b. Cytomegalovirus

c. Listeria monocytogenes

d. Syphilis

Solution. Ans-49: (d) Syphilis

Ref: Read the text below
Sol:
Syphilis does not cause an early abortion, because it can cross the thinned-out placental barrier only after 20th week of gestation.
It can however cause stillbirth and congenital syphilis.

Correct Answer. d

(50). A 25 year old female has 4 consecutive first trimester miscarriage, following investigation is must :-

a. VDRL

b. Pelvic USG

c. Anti Phospholipids antibodies, anticardiolipin antibodies

d. Hepatitis B Australia antigen

Solution. Ans-50: (c) Anti Phospholipids antibodies, anticardiolipin antibodies.

Ref: Read the text below
Sol:
Antiphospholipid antibodies including lupus anti coagulants and anticardiolipin antibodies causes repeated abortion by acting
against platelets & vascular endothelium

Correct Answer. c

(51). Umbilical cord insertion at the placental margin is called as :

a. Velamentous insertion

b. Vasa previa

c. Battledore insertion

d. Succenturiate lobe

Solution. Ans-51: (c) Battledore insertion

Ref: Dutta - 220
Sol:
Velamentous placenta cord attached to the membranes. A velamentous cord insertion may result in tearing of the vessels while
exercising controlled cord traction during 3rd stage of labour.
Vasa praevia if the leash of blood vessels happens to traverse through the membranes overlying the internal os, in front of presenting
part, the condition is called vasa praevia.
A battledore insertion of cord into the lower margin of the placenta may predispose to a cord presentation of cord prolapsed.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 20/97
(52). Augmentation in labour is a very important management. All of the following statements are correct regarding augmentation in labour
except

a. Amniotomy enhances the progress of labour in the first stage and negates the need for oxytocin administration

b. There is no increased risk of unfavourable maternal and neonatal adverse outcomes

c. Intermittent auscultation is equivalent to continuous electrical fetal monitoring when done in a 1:1 doctor/nurse to patient ratio

d. Twin gestation precludes the use of oxytocin for augmentation

Solution. Ans-52: (d) Twin gestation precludes the use of oxytocin for augmentation
Ref: Ressel G. ACOG Releases Report on Dystocia and Augmentation of Labor. Am Fam Physician. 2004;69(5):1285-1300
Sol:
Practice guidelines on dystocia and augmentation of labour
The guideline includes the following clinical considerations and recommendations:
Dystocia cannot be predicted with certainty. According to ACOG, risk factors (see accompanying table) for difficult delivery in
nulliparous women in the second stage of labor include short stature (less than 5 ft [150 cm]), age greater than 35 years, gestational age
greater than 41 weeks, interval between epidural induction and full cervical dilation for more than than six hours, fetal station above +2
cm at full cervical dilation, or occiput posterior fetal position.
Epidural anesthesia is associated with increases in duration of the first and second stages of labor, incidence of fetal malpositions,
use of oxytocin, and operative vaginal delivery. Epidural anesthesia was not shown to increase the cesarean delivery rate for dystocia.
No evidence supports routine use of intrauterine pressure catheters for labor management. They may be beneficial when the
evaluation of contractions is difficult because of obesity, there is a lack of one-on-one nursing care, or response to oxytocin is limited.
Walking during labor has not been shown to enhance or impair progress in labor. It is not harmful, and mobility may result in
greater comfort and ability to tolerate labor.
Not enough evidence is available to support the use of x-ray pelvimetry in patients whose fetuses have cephalic presentations.
Additional prospective studies are necessary to establish the usefulness of this diagnostic modality to predict dystocia, so it is not
recommended at this time.
Continuous support during labor from caregivers (nurses, midwives, or lay persons) has several benefits to the patients and
newborns without any evidence of harmful effects.
Active management of labor is not associated with unfavorable maternal or neonatal outcomes (option 2). It may lead to shortened
labor in nulliparous women, but it has not led to a consistent reduction in cesarean deliveries.
Current data do not support the theory that low-dose oxytocin regimens are superior to high-dose regimens for augmentation of
labor. Low-dose regimens are associated with less uterine hyperstimulation and lower maximum doses. High-dose regimens may be used
for multiparous women, but no data support the use of high-dose oxytocin regimens for augmentation in a patient with a previously
scarred uterus.
Twin gestation does not preclude the use of oxytocin for labor augmentation. Augmentation is not a significant risk factor for
cesarean delivery or adverse outcomes.
Amniotomy may enhance progress in the active phase and negate the need for oxytocin augmentation (option 1), but it may
increase the risk of chorioamnionitis.
No definitive evidence has identified the most effective method of fetal heart rate surveillance when oxytocin is used for
augmentation. Intermittent auscultation is equivalent to continuous electronic fetal monitoring when performed at specific intervals with
a one-to-one nurse-to-patient ratio (option 3). No data indicate the optimal frequency for intermittent auscultation in the absence of risk
factors.

Correct Answer. d

(53). A 30-year-old housewife reports with 6 months amenorrhoea. Her serum LH and FSH are high with low estradiol levels. What is the most
likely cause of amenorrhoea ?

a. Pituitary tumour

b. Polycystic ovarian disease

c. Exercise induced

d. Premature menopause

Solution. Ans-53: (d) Premature menopause

Ref: Shaws Textbook of Gynecology- 219
Sol:
Clinical conditions LH FSH Estrogen
Panhypopituitarism
Exogenous estrogen
Premature menopause
PCOD or Stein Leventhal syndrome Normal

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 21/97
(54). The following is always an indication of caesarean section, except :-

a. Abruptio placentae

b. Untreated stage of Ib Ca cervix

c. Active primary genital herpes

d. Type IV placenta praevia (major praevia)

Solution. Ans-54: (a) Abruptio placentae

Ref: Read the text below
Sol:
Cesarian section : Atypical indications.
(a) Abruptio placentae :
Not indicated in all cases of abruption.
Indication of caesarian section in abruption:
a. Fetal distress
b. Amniotomy could not be done
c. Amniotomy fails to control bleeding.
d. Associated complicating factors.
(b) Placenta praevia :
Indication of caesarian section
In severe (major) degree of placenta praevia (II-posterior, III, IV) caesarian section is indicated
for maternal interest even if fetus is dead.
Lesser degree of placenta praevia where amniotomy fails to stop bleeding or fetal distress appears.
Associated complicating factors with lesser degree of placenta praevia.
(c) In Ca cervix classical caesarian section should be done. Vaginal delivery should not be allowed because of cervical dystocia and
injuries.
(d) Caesarian section is indicated in active primary genital HSV infection where membranes are intact or recently ruptured.

Correct Answer. a

(55). Secondary hemorrhage following hysterectomy is most often due to :

a. Slipping of ligature

b. Sepsis

c. Injury to blood vessel

d. Coagulation failure

Solution. Ans-55: (b) Sepsis

Ref: Bailey and Loves Short Practice of Surgery - 60
Sol:
Types of haemorrhage :
1. Primary haemorrhage at the time of injury/operation.
2. Reactionary haemorrhage within 24 hrs (usually 4-6 hrs), mainly due to rolling (slipping) of ligature, dislodgement of a clot or
cessation of reflex vasospasm.
Secondary hemorrhage occurs after 7-14 days due to infection

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 22/97
(56). In surgical treatment of tubal infertility, best results are obtained in :

a. Salpingo-ovariolysis

b. Salpingostomy

c. Tubouterine implantation

d. Tubo-tubal anastomosis

Solution. Ans-56: (d) Tubo-tubal anastomosis

Ref: NMS Obs and Gyn, (4th Ed.) Pg. 364
Sol:
Correction of tubal factor :
1. Tubal anastomosis for reversal of sterilization.
2. Salpingoplasty for occluded distal and proximal fallopian tubes
3. Lysis of peritubal adhesions.
4. IVF/ET when fallopian tubes are absent or irreparable.
If pelvic tuberculosis with tubal disease is found on HSG tubal reconstructive surgery avoided.

Correct Answer. d

(57). The following are the signs of placental separation except

a. Fundal height is raised

b. Uterus becomes globular and ballottable

c. Flattening of the suprapubic region

d. Permanent lengthening of the cord

Solution. Ans-57: (c) Flattening of the suprapubic region

Ref.: Read the text below
Sol :
There is bulging of the suprapubic region following descent of the placenta in the lower segment.
Fundal height is raised
Uterus becomes globular and ballottable
Permanent lengthening of the cord.

Correct Answer. c

(58). Molar pregnancy is complicated by all; except :-

a. Hyperemesis

b. Thyrotoxicosis

c. Pregnancy-induced hypertension

d. Cardiac failure

Solution. Ans-58: (d) Cardiac failure

Ref: Read the text below
Sol:
Cardiac failure does not occur in a molar pregnancy.
Thyrotoxicosis occurs in 3%, hyperemesis is due to high HCG level, so also PIH, and respiratory syndrome.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 23/97
(59). The onset of action of oxytoxin on puerperal uterus, when it is used intravenously in case of post partum haemorrhage-

a. 30 sec

b. 45 sec

c. 1 min

d. 1 min

Solution. Ans-59: (a) 30 sec

Ref: Read the text below
Sol
The onset of action of oxytoxin, when given IV is 30 sec and when given IM 2 mins.
The onset of action of IV methyl ergometrine is 1 mins and by IM route - 7 mins.
Therefore, in case of PPH - one should start oxytoxin drip but injection methyl ergometrine also to be given because oxytoxin has its
action only for 8 mins while methyl ergometrine acts for 3 hours.

Correct Answer. a

(60). A patient with a history of recurrent abortions and hypercoagulable state is likely to be suffering from :

a. Anti-phospholipid antibody syndrome

b. Heparin induced thrombocytopenia

c. Leiden mutation

d. Anti-thrombin 3 deficiency

Solution. Ans-60: (a) Anti-phospholipid antibody syndrome

Ref.: Read the text below
Sol :
Antiphospholipid Antibody include lupus anticoagulant and anticardiolipin Antibody. They may be of IgG/M/A classes alone or in
combination.
They may be associated with Antiphospholipid Antibody syndrome, which is characterized by recurrent arterial or venous thromboses,
thrombocytopenia, and fetal losses and still births, especially in 2nd half of pregnancy.

Correct Answer. a

(61). All are risk factors for preterm delivery except :

a. Absence of fetal fibronectin at <37 weeks

b. Previous history of preterm baby

c. Asymptomatic cervical dilatation

d. Chlamydia infection of genital tract

Solution. Ans-61: (a) Absence of fetal fibronectin at <37 weeks

Ref.: Read the text below
Sol :
As fetal fibronectin is a protein that binds the decidual membrane together and can be detected in the cervicovaginal secretions only
before 22 weeks and again after 37 weeks with formation of LUS and stripping off of the membrane, however, if this protein is detectable
between 22-34 weeks, is an indication of pre-term onset of labor.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 24/97
(62). Study the given image, which procedure is being done ?

a. Pomeroy Procedure

b. Parkland Procedure

c. Kroener fimbriectomy

d. Irving Procedure

Solution. Ans-62: (b) Parkland Procedure

Ref.: Read the text below
Sol :
Pomeroy Procedure
This is the simplest method of dividing the tube. Plain catgut is used to ligate the knuckle of tube to ensure prompt absorption of the
ligature and subsequent separation of the severed tubal ends. Even so, ectopic pregnancy in the distal segment can occur (Berker and
colleagues, 2002).
Parkland Procedure
This procedure was developed in the 1960s. It was designed to avoid the initial intimate approximation of the cut ends of the oviduct
inherent with the Pomeroy procedure.

Correct Answer. b

(63). Regarding break-through bleeding (BTB) while using combined oral pills

a. It has no clinical significance as regard the efficacy of pills

b. Usually observed after 6 months of use

c. Patient should be advised to take higher dose oestrogen pills immediately

d. it is commonly due to subthreshold blood level of hormones

Solution. Ans-63 : (d) it is commonly due to subthreshold blood level of hormones.

Ref.: Read the text below
Sol :
There are other causes of BTB which should be excluded before advising immediate chane to higher dose pill.
It is common during the first 3 months of use.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 25/97
(64). Manchester operation is done for :

a. Fibroid

b. Septate uterus

c. Uterine prolapsed

d. Stress incontinence

Solution. Ans-64: (c) Uterine prolapsed

Ref.: Read the text below
Sol :
Manchester operation or Fothergills repair is done for genital prolapsed.
It combines anterior colporrhaphy + amputation of cervix and reconstruction + anterior placation of cardinal ligaments +
colpoperineorrhaphy.
Preserves menstrual and childbearing functions, but fertility is somewhat reduced (due to loss of cervical mucus).
The most common genital prolapsed is Cystocele.
Le Forts repair is reserved for very elderly menopausal women, who are unfit for any major surgical procedure.
Abdominal sling operation are preferred for: nulliparous prolapsed
Shirodkars sling operation is a modification of Fothergills operation, where the cervix is not amputated and later pregnancy
complications are avoided. Here, static slings strengthen the uterosacral ligaments.
In Purandares sling operation/cervicopexy, dynamic/open slings are fashioned from the rectus sheath.

Correct Answer. c

(65). The following are related to prophylactic chemotherapy in molar pregnancy

a. It may be given in at risk patients

b. Multiple agents are preferred

c. Malignant sequelae becomes nil

d. Following up is not required

Solution. Ans-65: (a) It may be given in at risk patients

Ref.: Read the text below
Sol :
The cytotoxic drugs are not safe; neither the chance of choriocarcinoma becomes nil. Single agent is the drug of choice as long as the
risk score (WHO) is < 8.

Correct Answer. a

(66). The best way to tackle the blood coagulation disorders in abruption placentae

a. Massive relatively fresh blood transfusion

b. To administer antifibrinolytic substances

c. To administer fibrinogen rich substances

d. Heparin

Solution. Ans-66: (a) Massive relatively fresh blood transfusion

Ref.: Read the text below
Sol :
Massive relatively fresh blood transfusion improves hypovolaemic state, increases tissue perfusion and increases production of
procoagulants either from the liver or reticuloendotheial cells.
This is in addition to the supply of fibrinogen in fresh blood

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 26/97
(67). Lymphatic drainage of clitoris is to :

a. Superficial inguinal lymph node

b. External iliac node

c. Deep inguinal lymph node of cloquet

d. Para aortic nodes

Solution. Ans-67: (c) Deep inguinal lymph node of cloquet

Ref.: Read the text below
Sol :
Lymphatic drainage :
Ovaries : para aortic LNs
Fallopian tube :
Along the ovary : para aortic LNs &
Along the cornua : superficial inguinal LNs
Uterus :
Cornua : superficial inguinal LNs
Fundus : para aortic LNs
Body: external iliac LN and internal iliac LNs
Cervix : drains to external iliac, internal iliac (Hypogastric), obturator & sacral nodes.
Vagina
Upper 1/3rd external, internal & common iliac nodes (like cervix)
Middle 1/3rd : Internal iliac nodes
Lower 1/3rd Superficial inguinal LNs
Rd Superficial inguinal LNS
Vulva : Superficial inguinal LNS (sentinel Lymph node) and then deep inguinal LNs
Clitoris : deep inguinal nodes of Cloquet
Glans penis : deep inguinal nodes of Cloquet (same as clitoris)
Rest of penis : superficial inguinal LNs
Testis : pre & para aortic LNs

Correct Answer. c

(68). Regarding chicken pox in pregnancy

a. The incubation period is 7-10 days

b. Maternal infection after 20 weeks may cause fetal varicella syndrome (FVS)

c. Oral acyclovir within 24 hours of rash can reduce the severity of symptoms

d. Varicella Zoster immunoglobulin (VAZIG) with 24 hours of contact can prevent FVS.

Solution. Ans-68: (c) Oral acyclovir within 24 hours of rash can reduce the severity of symptoms
Ref.: Read the text below
Sol :
Incubation period is 10-20 days
Maternal infection before 20 weeks only can cause FVS in 1-2% of cases.
Oral acyclovir should be given after 20 weeks of gestation only
There is no evidence that AZIG can prevent FVS.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 27/97
(69). Better births initiative (WHO) recommends the following

a. Routine acceleration of labour

b. Routine amniotomy (ARM)

c. No routine suctioning of neonates who have not been exposed to meconium

d. Women in labour must be restricted to bed as a routine.

Solution. Ans-69: (c) No routine suctioning of neonates who have not been exposed to meconium
Ref.: Read the text below
Sol :
There is no evidence of any benefit for routine interventions like routine enemas, amniotomy, acceleration of labour, episiotomy,
restriction to bed for all women and routine suctioning to all neonates.
These interventions are therefore to be avoided as a routine practice.

Correct Answer. c

(70). Concerning bearing down efforts, in relation to labour, all are correct except

a. Normal second stage

b. Abnormal first stage

c. Abnormal third stage

d. Unaltered fetal heart rate

Solution. Ans-70: (d) Unaltered fetal heart rate

Ref.: Read the text below
Sol :
Apart from its normal appearance in second stage of labour, it may appear even in first stage in association with spastic lower
segment.
In inversion of the uterus, bearing down sensation is characteristic.
There is slowing of FHR which recovers quickly

Correct Answer. d

(71). A primigravida has delivered twins. She is designated as :

a. G2 P2

b. G1 P1

c. G1 P2

d. G2 P0

Solution. Ans-71: (b) G1 P1

Ref.: Read the text below
Sol :
Gravida and Para refer to pregnancies and not to babies. As such, a woman who delivers twins in first pregnancy is still a gravida one
and Para one.
A pregnant woman with a previous history of two abortions and one term delivery can be expressed as fourth gravida but primipara.
It is customary in clinical practice to summarize the past obstetric history by two digits (the first one relates with viable births and the
second one relates with abortion) connected with a plus sign affixing the letter P.
Thus P1 denotes the patient had two viable births and one abortion.
A pregnant woman with a previous history of four births or more is called grand multipara.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 28/97
(72). Study the given image, unwanted pregnancies during the first year of perfect use is about ?

a. 0.6 percent

b. 6 percent

c. 20 percent

d. 35 percent

Solution. Ans-72 : (a) 0.6 percent

Ref.: Read the text below
Sol :

Intrauterine contraceptive devices: Copper-containing ParaGard T 380A (left) and levonorgestrel-releasing Mirena (right).
Unwanted pregnancies during the first year of perfect use are 0.6 percent for the copper-containing ParaGard T 380A and 0.1
percent for the levonorgestrel-containing Mirena.
Respective typical failure rates are 0.8 percent and 0.1 percent.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 29/97
(73). Not a reliable investigation for tubal patency :

a. Air insufflations test

b. Laparoscopic chromotubation

c. Hysterosalpingography

d. Sonosalpingography

Solution. Ans-73: (a) Air insufflations test

Ref.: Read the text below
Sol :
Drawbacks of Air insuffation test : In about one-third of cases. It gives false negative findings due to corneal spasm.
It also cannot identify the side and site of the block in the tube. As such, it is inferior to other methods of tubal study

Correct Answer. a

(74). The following tests are related to blood coagulation disorder in obstetrics except

a. Thrombocytopenia is a feature of fibrinolytic process and not of DIC

b. In DIC, RBC will be helmet shaped or fragmented but in fibrinolytic process, the cell morphology is normal.

c. Weiner clot observation test gives a rough estimate of total blood fibrinogen level

d. Thrombocytopenia can be diagnosed from the periopheral smear.

Solution. Ans-74: (a) Thrombocytopenia is a feature of fibrinolytic process and not of DIC
Ref.: Read the text below
Sol :
Thrombocytopenia is a feature of DIC and not fibrionlytic process
In DIC, RBC will be helmet shaped or fragmented but in fibrinolytic process, the cell morphology is normal.
Weiner clot observation test gives a rough estimate of total blood fibrinogen level
Thrombocytopenia can be diagnosed from the periopheral smear.

Correct Answer. a

(75). Bartholins duct opens into:

a. Upper part of vagina

b. Lower part of vagina

c. Labia majora

d. Groove between labia minora and Hymen

Solution. Ans-75: (d) Groove between labia minora and Hymen

Ref.: Read the text below
Sol :
Bartholins glands are pea sized lobulated racemose glands that lie in the superficial perineal pouch embedded in posterior part of
vestibular bulb.
They are homologous to Cowpers/Bulbo-urethral glands in males.
The gland is lined by columnar epithelium, but the duct is lined by transitional epithelium.
The gland produces alkaline mucus during sexual excitement.
The duct is 2 cm long and opens into the vestibule outside the hymen at the junction of the anterior 2/3rd and posterior 1/3 rd in the
groove between the hymen and labia minora.
The treatment of choice for Bartholins abscess is incision and Drainage.
The treatment of choice for Bartholins cyst is Marsupialisation

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 30/97
(76). Which of the following is a feature of the secretory phase?

a. Sub-nuclear vacuolation

b. Simple tubular glands

c. Endometrial thickness of 4-5 mm

d. Spinbarkeit phenomenon

Solution. Ans-76: (a) Sub-nuclear vacuolation

Ref.: Read the text below
Sol :
SECRETORY PHASE :
Sub nuclear vacuolation is a characteristic feature of the endometrium in the secretory phase
The epithelial cells develop spherical translucent areas between the nuclei and the basement membrane
Fluid in the subnuclear vacuoles consists of mucin and glycogen.
It is the earliest evidence of ovulation and persists until about the 21st day of the cycle
This appearance is a presumptive evidence of progesterone activity.
Best diagnosis of ovulation is via : Endometrial biopsy.

Correct Answer. a

(77). Most common type of epithelial ovarian cancer associated with endometriosis

a. Mucinous

b. Clear cell

c. Endometroid

d. Papillary serous

Solution. Ans-77: (b) Clear cell

Ref: Read the text below
Sol :
Most common are epithelial ovarian cancers account for 80-90%
Most common type of epithelial ovarian cancer associated with endometriosis is clear cell.
Most common benign ovarian tumour is serous cyst adenoma
Most common malignant ovarian tumour is serous cyst adenocarcinoma
Most common germ cell malignancy is immature teratoma
Most common ovarian tumour during pregnancy is dermoid

Correct Answer. b

(78). If one twin is in a transverse lie and other is vertex, the most appropriate route of delivery is

a. Cesarean section

b. Internal podalic version followed by breech extraction

c. Both

d. Either

Solution. Ans-78: (a) Cesarean section

Ref: Read the text below
Sol :
Some authors have recommended cesarean section as the appropriate method of delivery whether other twin vertex.
Another alternative to cesarean section is ultrasound guided, external cephalic version of the second twin.
If twin A is breech, and twin B is vertex, there is the small possibility of "locking" (about 1 per 1,000 twin deliveries) whereby the
entry of the first twin's head into the pelvis is obstructed but he head of the second.)

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 31/97
(79). The frequency of Dizygotic twins is greatest in which of the following age groups?

a. 40-45

b. 35-40

c. 25-30

d. 20-25

Solution. Ans-79: (b) 35-40

Ref: Read the text below
Sol :
The frequency of Dizygotic twins is affected by race, maternal age, ovulation induction, and parity.
The frequency of Dizygotic is highest in blacks, lowest in Asians, and intermediate in whites.
The incidence of Dizygotic twinning increases with the maternal age until the age of 40, after which it decreases.
There is some evidence of an increased incidence maternal parity.

Correct Answer. b

(80). All are the Mesonephric (Wolffian) remmants except

a. Gartners duct

b. Ovarian ligament

c. The epoophoron

d. The paroophoron

Solution. Ans-80: (b) Ovarian ligament

Ref.: Read the text below
Sol :
Ovarian ligament is development from the proximal part of gubernaculums.
The distal part remains as round ligament.

Correct Answer. b

(81). Indications of prophylactic chemotherapy in molar pregnancy are all except

a. When hCG level following evancuation fails to become normal by 6-8 weeks time

b. In a woman with number of high risk factors for malignanct change

c. Preferably as a routine to all cases following evacuation

d. In cases where there is re-elevation of hCG level following its initial normalization

Solution. Ans-81: (c) Preferably as a routine to all cases following evacuation

Ref.: Read the text below
Sol :
Routine use of cytoxic drugs prophylactically is not recommended considering their toxicity.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 32/97
(82). When the vertex is well flexed presentation is:

a. Cephalic

b. Vertex

c. Face

d. Brow

Solution. Ans-82: (a) Cephalic

Ref.: Read the text below
Sol :
Presentation will be cephalic with vertex being the most common presenting part.

Correct Answer. a

(83). All are treatment for Stress Urinary Incontinence SUI except :

a. Kellys placation

b. Marshall-Marchetti-Krants Operation

c. Bursch Colposuspension

d. All of the above

Solution. Ans-83: (d) All of the above

Ref.: Read the text below
Sol :
SUI : Stress Urinary Incontinence, whichis defined as urinary incontinence with activities (laughing/coughing, etc) that increase intra-
abdominal pressure, in the absence of detrussor activity, basic cause being distortion of urethrovesical angle which may be the result of
weakening of pelvic floor muscles as following child-birth vaginally, post menopausally with hypo-estrogenic state, excess tobacco
eaters.

Correct Answer. d

(84). Which of the following structures is most important for support of the female pelvic viscera?

a. The supporting fasciae

b. The perivascular stalk as a suspensory structure

c. The uterosacral ligament

d. The levator ani muscle

Solution. Ans-84: (d) The levator ani muscle

Ref.: Read the text below
Sol :
The thick public parts of the levator ani form a puborectal sling for the rectum, drawing it forward until it forms a sloping shelf.
Upon this shelf the vagina rests, and on the vagina rests the bladder. This is the essential support. The public pars of the levator ani
also insert into the perineal body and thus act as a sling for the posterior wall of the vagina.
The urgenital diaphragm and its fascias blend with the lower third of the vagina and assist the levator ani to support it.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 33/97
(85). Which of the following ovarian tumor is associated with genital complications?

a. Theca cell

b. Granulosa cell

c. Dysgerminoma

d. Choriocarcinoma

Solution. Ans-85: (c) Dysgerminoma

Ref.: Read the text below
Sol :
Dysgerminoma is the most common malignant germ cell tumor. It arises from undifferentiated form of germ cells.
It is often associated with gonadal dysgenesis or androgen insensitivity syndrome or true hermaphroditism.

Correct Answer. c

(86). Conization is used as treatment/choice in:

a. CIN-1

b. CIN-2

c. CIN-3

d. All the above

Solution. Ans-86 : (d) All the above

Ref.: Read the text below
Sol :
When the diagnosis is made by biopsy of a CIN lesion, there are several treatments that may ensue.
For small lesions confined to the exocervix with invasive disease ruled out, cryo-therapy or laser therapy may be used to destroy the
epithelial issue without causing extensive damage to the cervix.
If the lesion involves the endocervix surgical excision of the transformation zone and distal endocervical canal must ensue.
The loop electrosurgical excisions procedure (LEEP) or surgical conization can be performed to remove endocervical lesions.
In general, the LEEP removes cervical tissue with out causing an extensive damae to the stroma off the cervix, although scarring of the
endocervical canal still ensues.
The specimens of excisions should always be sent to pathology to ensure adequate margins surrounding the excised lesions

Correct Answer. d

(87). A 12-year old girl presents with history of child abuse. She is bleeding profusely from the genitalia, with severe perineal injuries and
fractured pelvis. The most appropriate management for her would be

a. Internal iliac ligation

b. Urgent blood transfusion

c. Assess airway

d. Inform police before initiating treatment

Solution. Ans-87: (b) Urgent blood transfusion

Ref: Dutta - 145
Sol:
Any patient presenting with profuse blood loss needs to be hemodynamically stabilized first.
On top of that, in this particular case, the patient has a pelvic fracture, which has a greater chance of causing a major vascular
injury.
Therefore, the most appropriate management would be to stabilize the patient with urgent blood transfusion.
While the patient is being stabilized, the police can be informed regarding the abuse history.
In this case, there is no point in wasting time assessing the airway as there is no reason for the airway to get compromised.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 34/97
(88). The screening tests for breast and genital cancer in females include all of the following tests except

a. Office endometrial aspirate for endometrial cancer

b. CA-125 for ovarian cancer

c. Pap smear for cervical cancer

d. Mammography for breast cancer

Solution. Ans-88: (a) Office endometrial aspirate for endometrial cancer

Ref: Dutta - 145
Sol:
There is no role of office endometrial aspiration in screening of endometrial cancer. It is only recommended for diagnosis of endometrial cancer in symptomatic women.
Option 3: Pap smear for cervical cancer and Option 4: Mammography for breast cancer
Ref: Zoorob R, Anderson R, Cefalu C and Sidani M. Cancer Screening Guidelines. Am Fam Physician. 2001;63(6):1101-1113.

ACOG screening recommendations

Breast cancer
Mammography Every 1 to 2 years starting at age 40, yearly after age 50
Clinical breast examination Yearly (or as appropriate) general health evaluation that includes examination to detect signs of premalignant or malignant conditions
Cervical cancer
Annual Pap test and pelvic examination beginning at age 18 or when sexually active; after 3 or more tests with normal results.
Pap smear
Pap test may be performed less frequently on physician's advice.

Option 2: CA-125 for ovarian cancer

Ref: ACOG committee opinion. The Role of the Obstetrician-Gynecologist in the Early Detection of Epithelial Ovarian Cancer.
(http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/The-Role-of-the-Obstetrician-Gynecologist-in-the-Early-Detection-of-Epithelial-Ovarian-Cancer)

Factors known to increase the risk of ovarian cancer include an identified BRCA gene mutation and a family history of cancer, which is suggestive of a hereditary cancer syndrome.
Women with these conditions should be referred for formal genetic counseling to better assess their cancer risk, including risk of ovarian cancer.
If appropriate, these women may be offered ovarian cancer screening.
Screening with CA 125 measurement and transvaginal ultrasonography every 6 months has been recommended for high-risk women by the National Com-prehensive Cancer Network, although
evidence is insufficient to demonstrate that current screening methods improve survival rates for these women.
The American College of Obstetricians and Gynecologists recommends that risk-reducing salpingo-oophorectomy, which includes removal of the ovaries and fallopian tubes in their entirety, be
offered by age 40 years for women with BRCA1 or BRCA2 mutations.

Correct Answer. a

(89). A 38 weeks gestation multi gravid with history of pre-eclampasia presents to you with urine output = 1000 ml; BP = 130/90 mm Hg;
Urine Protein = within normal limits. Management includes :

a. Immediate LSCS

b. Delivery at term normally

c. Delivery at 42 weeks

d. Terminate pregnancy

Solution. Ans-89: (b) Delivery at term normally

Ref.: Read the text below
Sol :
Mild Pre-eclampsia (140/90 to 160/110 mmHg without seizures)
Because delivery is the ultimate treatment for pre-eclampsia, induction off labor is the treatment of choice for pregnancies at term,
unstable pre-term pregnancies, or pregnancies where there is evidence of fetal lung maturity.
In these cases, vaginal delivery may be attempted with the assistance of prostaglandins, pitocin, or amniotomy as needed.
Cesarean delivery need only be performed for obstetric indications.
For preterm patients who are stabilized, bed rest and expectant management may be used. Once the patient reaches term, shows
evidence of fetal lung maturity, or worsening pre-eclampsia, delivery is advised.
All pre-eclampic patients should e started on magnesium sulfate therapy for seizure prophylaxis (4 to 6 g load and 2 g/h) during labor
and delivery and it should be continued until 12 to 24 hours after delivery.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 35/97
(90). Various techniques of female sterilization include all of the following except :

a. Clipping

b. Ligating

c. Banding

d. Sclerosing agents

Solution. Ans-90: (d) Sclerosing agents

Ref.: Read the text below
Sol :
Tubal Sterilization
Method of Action
Tubal sterilization prevents pregnancy by surgically occluding both fallopian tubes to prevent the ovum and sperm from uniting.
There are a number of methods by which tubal occlusion can be accomplished, including banding, clipping, and coagulating and/or
ligating the fallopian tubes.
These procedures are performed under general anesthesia.
The most commonly used method, the pomeroy tubal ligation

Correct Answer. d

(91). Complications of benign ovarian tumors are all of the following :

a. Torsion

b. Bleeding

c. Pseudomyxoma

d. Metastasis

Solution. Ans-91: (d) Metastasis

Ref.: Read the text below
Sol :
Complications of Benign Ovarian Tumors
The following complications may occur in benign ovarian tumors :
Torsion of the pedicle (axial rotation).
Intracystic hemorrhage.
Infection
Rupture
Pseudomyxoma peritonel.
Malignancy

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 36/97
(92). Elective ceasarean section (C.S.), even if at term, can lead to an inceased incidence of medical
complications and adverse outcomes. The universal recommendation for elective C.S. is at how
many weeks?

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 37/97
 a. 37 weeks

b. 38 weeks

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 38/97
 c. 39 weeks

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 39/97
 d. 40 weeks

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 40/97
 Solution. Ans-92: (c) 39 weeks
Ref: Williams Obstetrics, 23/e, pg 548
Sol:
As ceasarean delivery has become safer and more commonly performed, and women have
taken a more active role in their obstetrical care, it has been argued that women should be able to
choose to undergo elective ceasarean delivery.
This has become one of the most important and controversial issues currently facing the
speciality.
Reasons for mothers to request ceasarean delivery include
o Avoidance of pelvic floor injury during vaginal birth
o Avoidance of the uncertainty and pain of labour and
o Convenience.
It was observed in a study that one third of women who delivered at an institution entered
spontaneous labour at term, and 96 percent of these delivered without adverse neonatal outcomes.
Thus, the debate surrounding ceasarean delivery on maternal request includes its medical
rationale from both a maternal and fetal-neonatal standpoint.
To address this, a panel of experts critically reviewed available literature to form
recommendations based on risks and benefits identified.
The panel was able to draw some conclusions from the existing data.
o Ceasarean delivery on maternal request should not be performed prior to 39 weeks gestation
unless there is evidence of fetal lung maturity.
o It should be avoided in women desiring several children because of the risk of placenta accreta.
o Finally, it should not be motivated by the unavailability of effective pain management.
Caesarean section is defined as delivery of a viable fetus through an incision in the abdominal wall
and intact uterus.
INDICATIONS
Previous Caesarean section
Dystocia or dysfunctional labour
Cephalopelvic disproportion
Tumors complicating pregnancy
Fetal macrosomia
Malpresentations like brow and transverse lie and persistent mentoposterior
Deep transverse arrest
Abnormal uterine action
Threatened rupture and obstructed labour
Failed forceps or vacuum
Failed induction
Fetal distress and cord prolapse
Breech presentation (selected cases)
Other fetal indications
Severe IUGR
Multiple pregnancy(first twin is non-vertex and monoamniotic twins)
Antepartum haemorrhage
Placenta previa
Abruptio placenta
Vasa previa
Maternal problems
Elderly nullipara
Prolonged period of infertility or pregnancy following in vitro fertilisation
Bad obstetric history
Previous history of nulliparous prolapse,stress incontinence or fistula
HIV complicating pregnancy
Many cases of severe pre-eclampsia and diabetes
Caesarean section on maternal request

TYPES OF CAESAREAN SECTION

1. Lower segment Caesarean section Usually incision is the Pfannensteil incision (transverse
curvilinear incision just above the pubic hairline)

2. Lower segment vertical incision

Differences between transverse and vertical incisions
Transverse incision Vertical incision
Cosmetic appeal More Less
Postoperative pain Less More
Wound dehiscence Less chance More chance
Incisional hernia Less chance More chance
Technical skill More technical skill needed Less technical skill
Time taken More time consuming Less time consuming
Access to upper abdomen Less access Good access

3. Classical Caesarean Section

Uterine incision is made in the anterior uterine wall in the upper segment
above the reflection of the uterovesical fold of peritoneum.
Indications are:
Lower segment is unapproachable due to extensive adhesions or myomas
Carcinoma cervix
Anterior placenta previa with a previous caesarean (especially adherent placenta)
Some cases of transverse lie with ruptured membranes (especially in dorsoinferior)
Conjoined twins

Differences between LSCS and classical scar

LSCS scar Classical scar
Apposition Better apposition Difficult to appose
Imperfect due to contraction
Better as the lower segment is
Healing in puerperium and retraction of upper
quiescent
segment
Placental implantation May be over the scar Much likely over the scar
Rupture 0.5-2 % 4-8 %
Timing of rupture Usually in labour In pregnancy and labour

4.Extraperitoneal Caesarean section

Method of dealing with severe infection
Uterus is opened in an extraperitoneal approach without entering into the peritoneal cavity,
by dissecting through the space of Retzius beneath the bladder.

5. Caesarean hysterectomy
Indications are:
Severe atonic postpartum haemorrhage
Placenta accrete,increta or percreta
Severe sepsis
Multiple large myomas
Carcinoma in situ of cervix

6. Perimortem Caesarean section

Refers to emergency caesarean section in a woman who has had a cardiac arrest to save a live
fetus

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 41/97
 Correct Answer. c

(93). Blood supply to the uterus at term is:

a. 1000 ml/min

b. 50 ml/min

c. 500 ml/min

d. 750 ml/min

Solution. Ans-93: (d) 750 ml/min

Ref.: Read the text below
Sol :
Uterine blood flow is increased from 50 ml per minute in non-pregnant state to about 750 ml near term.
Pulmonary blood flow (normal 6000 ml/min) increased by 2500 ml per minute.
Renal blood flow (normal 800 ml) increases by 400 ml per minute at 16th week and remains at this level till term.
The blood flow through the skin and mucous membranes reaches a maximum of 500 mi/minute by 36th week.
Heat sensation, sweating or stuffy nose complained by the pregnant women can be explained by the increased blood flow.

Correct Answer. d

(94). Maturation index during pregnancy shifts to the right in all the conditions except

a. Threatened abortion

b. Missed abortion

c. Post term pregnancy

d. Post menopause women

Solution. Ans-94: (d) Post menopause women

Ref.: Read the text below
Sol :
Maturation Index:
Maturation Index It is the percentage study of the parabasal , intermediate, and superficial squamous cells100 cells counted from
exfoliated epithelial cells of healthy vaginal smear. It is determined by morphology of the nucleus and thickness of cytoplasm of epithelial
cells.

Reading of the maturation index:

Reading of the maturation index 1- Shift to the right : indicate an increase number of superficial cell (maturation) i.e. 0100 under the
effect of increase estrogen.
Shift to the left : indicate an atrophic effect e.g. post menopause women i.e 100 with no effect of estrogen.
Shift to the mid-zone : means progesterone like effect e.g. secretory phase of endometrium i.e. 0100
Maturation Index (MI) and Papanicolaou Smear Usage :
Maturation Index (MI) and Papanicolaou Smear Usage
Normal Maturation Index:
Normal Maturation Index 1- New born (up to 8 weeks) - Increased number of intermediate cells with glycogen in the cytoplasm, similar
to pregnancy cells: due to the effect of maternal hormones on the infant blood. 2- Infancy (8 weeks puberty) - Vaginal smear shows
mainly parabasal cells similar to post-menopausal period (vaginal atrophy).

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 42/97
(95). Largest fetal head diameter:

a. Occipitofrontal

b. Suboccipitofrontal

c. Mentovertical

d. Submentovertical

Solution. Ans-95: (c) Mentovertical

Ref.: Duttas-85
Sol :
Occipitofrontal (11.5 cm) extends from the occipital eminence to the root of the nose.
Suboccipitofrontal (10 cm) extends from the nape of the neck to the anterior end of the anterior fontanelle.
Mentovertical (14 cm) extends from the midpoint of the chin to the highest point on the sagittal suture
Submentovertical (11.5) extends from the junction of the mouth and neck to the highest point on the sagittal suture.

Correct Answer. c

(96). Pelvis with only one ala is known as :

a. Rachitic pelvis

b. Naegeles pelvis

c. Scoliotic pelvis

d. Roberts pelvis

Solution. Ans-96: (b) Naegeles pelvis

Ref.: Duttas Obstetrics-347
Sol :
If ala is absent on one side, it is naegeles pelvis.
If alae of both the sides are absent, it is known as Roberts pelvis
Delivery in both the condition is done by caesarean section

Correct Answer. b

(97). Which is most commonly used radiation sensitiser for treatment of cervical cancer

a. Paclitaxel

b. Carboplatin

c. 5 FU

d. Cisplatin

Solution. Ans-97: (d) Cisplatin

Ref: Read the text below
Sol :
CHEMO RADIATION
Give chemotherapy and radiotherapy concurrently
Cisplatin is most commonly used followed by 5 FU
External beam radiotherapy is followed by brachytherapy
External beam radiotherapy - 25 fractions given as 5 fractions per week
Each fraction is 180-200 cGy( pelvic radiation)

Brachytherapy Point A - 8000cGy

Point B- 6000cGy
Radioisotopes used are external beam- caesium
Brachytherapy high dose - iridium and low dose - caesium

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 43/97
(98). Uterine artery crosses ureter at what distance from cervix

a. 1cm

b. 2cm

c. 3cm

d. 4cm

Solution. Ans-98: (b) 2cm

Ref: Read the text below
Sol :
Ovarian vascular pedicle dilates 3 times in pregnancy by term
Uterine artery crosses ureter 2 cm lateral to cervix at level of internal os anterior division of internal iliac is Ligated 5cm distal to
bifurcation of common iliac
Weight of uterus immidiately after delivery 1000gm
Volume of uterus at term is 5litres
Pain from uterine contraction t11-t12

Correct Answer. b

(99). Average length of umbilical cord is

a. 30 cm

b. 55cm

c. 75cm

d. 100cm

Solution. Ans-99: (b) 55cm

Ref: Read the text below
Sol :
Placenta formed from chorion frundosum
Weight of placenta:fetus is 1:6
Placenta is only formed from product of conceptus
Human placenta is hemochorioendothelial
Function of placenta is determined by HPL
Surface area of placenta at term is 12 m2
Placenta takes over function of corpus luteum at 8 weeks-10 weeks
Functional unit of placenta is lobule
Cytotrophoblast lack HLA antigen extra villus Cytotrophoblast have HLA g
Placenta synthesises progesterone from maternal LDL
No of spiral arterioles in intervillous space at term 120
Decidua capsularis and parietalis fuse at 14-16 weeks of gestation
Umbilical cord length 30-100 cm and average length is 55 cm

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 44/97
(100). Ideal number of antenatal visits :

a. 12-14

b. 6-8

c. 7-9

d. 10-11

Solution. Ans-100: (c) 7-9

Ref.: Read the text below
Sol :
ACOG recommends a visit of every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, and weekly till delivery.
This amounts to 13 if the 1st visit was at 8 weeks and the last at 40 weeks.
In contrast a recent expert committee suggested a reduction to 8 visits for women normal and uncomplicated pregnancies.

Correct Answer. c

(101). On digital examination of the apical region of the vagina, the structure presented first to the examining finger is the posterior lip of the
cervix. This observation precludes which of the following uterine postures?

a. Antiflexion

b. Anteversion

c. Retroflexion

d. Retroversion

Solution. Ans-101: (d) Retroversion

Ref.: Read the text below
Sol :
The normal posture of the uterus is anteverted and anteflexed.
If the anterior lip of the cervix is palpated first during vaginal examination, the cervix is in an anteverted position.
If the cervix is retroverted, either the cervical os or the posterior lip of the cervix is the first structure to be palpated.

Correct Answer. d

(102). Litzmans obliquity is:

a. Posterior asynclitism

b. Anterior asynclitism

c. Same as naegeles obliquity

d. None of the above

Solution. Ans-102: (a) Posterior asynclitism

Ref.: Read the text below
Sol :
When the sagittal suture lies nearer the symphysis, the posterior parietal bone becomes the leading presenting part.
It is then termed, posterior parietal presentation or posterior asynclitism (Litzmans obliquity).
When the sagittal suture is nearer the sacral promontory, an anterior parietal presentation results. This is termed anterior asynclitism
or Naegeles obliquity.
Moderate degrees of asynclitism are the rule in labor.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 45/97
(103). Oxytocin has a plasma half-life of about is

a. 1-2 minutes

b. 3-5 minutes

c. 5-6 minutes

d. 7-8 minutes

Solution. Ans-103: (b) 3-54 minutes

Ref.: Read the text below
Sol :
The sensitivity of the uterus to oxytocic activity increases progressively throughout pregnancy until term when it is maximal.
Oxytocin is distributed throughout the extracellular fluid.
Small amounts of this drug probably reach the fetal circulation.
Oxytocin has a plasma half-life of about 3 to 5 minutes.
Following parenteral administration, uterine response occurs within 3 to 5 minutes and persists for 2 to 3 hours.
Its rapid removal from plasma is accomplished largely by the kidney and the liver. Only small amounts oxytocin are excreted in the
urine unchanged.

Correct Answer. b

(104). In suction evacuation for MTP, the pressure of the suction is raised to

a. 100-200 mm Hg

b. 200-300 mm Hg.

c. 400-600 mm Hg.

d. 700-900 mm Hg.

Solution. Ans-104: (c) 400-600 mm Hg.

Ref.: Read the text below
Sol :

Vacuumor suction aspiration uses aspiration to remove uterine contents through the cervix. It may be used as a method of induced
abortion, a therapeutic procedure used after miscarriage, or a procedure to obtain a sample for endometrial biopsy. The rate of infection
is lower than any other surgical abortion procedure at 0.5%.
Some sources may use the terms dilation and evacuationor "suction" dilation and curettageto refer to vacuum aspiration, although
those terms are normally used to refer to distinct procedures.
In suction evacuation for MTP, the pressure of the suction is raised to
400-600 mm Hg.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 46/97
(105). Capacitation involves all except

a. Increase in DNA content of sperm nucleus

b. Time required is 2-4 hours.

c. Enzyme hyaluronidase is related

d. It helps to penetrate the cumulus oophorus.

Solution. Ans-105: (d) It helps to penetrate the cumulus oophorus.

Ref.: Read the text below
Sol :

Capacitationis the penultimate step in the maturation of mammalian spermatozoa and is required to render them competent to
fertilize an oocyte. This step is a biochemical event; the sperm move normally and look mature prior to capacitation. In vivo this step
typically occurs after ejaculation, in the female reproductive tract. In vitro, capacitation can occur by incubating sperms that have either
undergone ejaculation or have been extracted from the epididymis in a defined medium for several hours.
The uterus aids in the steps of capacitation by secreting sterol-binding albumin, lipoproteins, proteolytic and glycosidasic enzymes
such as heparin.
Non-mammalian spermatozoa do not require this capacitation step and are ready to fertilize an oocyte immediately after release
from the male. After this capacitation the sperm must undergo activation involving the acrosome reaction.
Capacitation involves the destabilisation of the acrosomal sperm head membrane allowing greater binding between sperm and
oocyte. This change is facilitated by the removal of steroids (e.g. cholesterol) and non-covalently bound epididymal/seminal
glycoproteins. The result is a more fluid membrane with an increased permeability to Ca2+.
An influx of Ca2+ produces increased intracellular cAMP levels and thus, an increase in motility. Hyperactivation coincides with the
onset of capacitation and is the result of the increased Ca2+ levels. The tripeptide FPP (fertilization promoting peptide) produced by the
male is essential for capacitation (high levels of FPP prevent capacitation, the proper concentration occurs after ejaculation in the female
reproductive tract where the concentration drops after mixing with vaginal secretions and/or becomes less active due to the pH of the
vagina). It has a synergistic stimulatory effect with adenosine that increases adenylyl cyclase activity in the sperm. FPP is found in the
seminal fluid (FPP produced in prostate gland), and comes into contact with the spermatozoa upon ejaculation.

Correct Answer. d

(106). The following changes occur in the vascular system of the newborn after birth

a. Distal parts of the obliterated umbilical arteries form superior vesical arteries

b. Umbilical vein becomes ligamentum venosum

c. Ductus venosus becomes ligamentum teres

d. Functional closure of the ductus arteriosus occurs soon after birth

Solution. Ans-106: (d) Functional closure of the ductus arteriosus occurs soon after birth
Ref.: Read the text below
Sol :
The distal parts of obliterated umbilical arteries become lateral umbilical ligaments.
Umbilical vein becomes ligamentum teres.
Ductus venous becomes ligamentum venosum

Correct Answer. d

(107). The optimum interval between uterine incision and delivery during caesarean section should be

a. Less than 90 seconds

b. Between 90 and 180 seconds

c. Between 180-210 seconds

d. Between 210-240 seconds.

Solution. Ans-107: (a) Less than 90 seconds

Ref.: Read the text below
Sol :
Incision and manipulation of the uterus cause reflex uterine vasoconstriction resulting in fetal asphyxia.
Interval > 90 seconds are associated with significant lowering of Apgar scores.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 47/97
(108). Common benign ovarian tumour with potentiality of torsion in pregnancy

a. Dermoid cyst

b. Pseudomucinous cyst adenoma

c. Corpus luteum of pregnancy

d. Papilliferous cyst

Solution. Ans-108: (a) Dermoid cyst

Ref.: Read the text below
Sol :
Ovarian dermoid cyst and mature cystic teratoma are terms often used interchangeably to refer to the most common ovarian
neoplasm. Although they have very similar imaging appearances, the two have a fundamental histological difference: dermoids are
composed only of dermal and epidermal elements, whereas teratomas have mesodermal and endodermal elements.
For the sake of simplicity both are discussed in this article, as much of the literature combines the two entities.
Epidemiology
Mature cystic teratomas account for 10-20% of all ovarian neoplasms. They tend to be identified in young women, typically around the
age of 30 years and are also the most common ovarian neoplasm in patients younger than 20 years.
Clinical presentation
Uncomplicated ovarian dermoids tend to be asymptomatic and are often discovered incidentally. They do however predispose to ovarian
torsion, and may then present with acute pelvic pain.
Other complications (listed further down in the article) are less common.
Pathology
Mature cystic teratomas are encapsulated tumours with mature tissue or organ components. They are composed of well-differentiated
derivations from at least two of the three germ cell layers (ectoderm, mesoderm, and endoderm). They therefore contain developmentally
mature skin complete with hair follicles and sweat glands, sometimes luxuriant clumps of long hair, and often pockets of sebum, blood,
fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue. Typically their diameter is smaller than 10 cm, and rarely more than 15 cm.
Real organoid structures (teeth, fragments of bone) may be present in ~ 30% of cases.
Location - laterality
They can be bilateral in 10-15% of cases 1-2
Variants
struma ovarii tumour - contains thyroid elements, however sometimes these are seperately classified as specialised teratomas of the
ovaries.
Radiographic features
Plain film
May show calcific and tooth components with the pelvis
Pelvic ultrasound
Ultrasound is the preferred imaging modality. Typically an ovarian dermoid is seen as a cystic adnexal mass with some mural
components. Most lesions are unilocular.
The spectrum of sonographic features includes
Rokitansky nodule - dermoid plug
Diffusely or partially echogenic mass with posterior sound attenuation owing to sebaceous material and hair within the cyst cavity
( echogenic interface at edge of mass that obscures deep structures): the tip of the iceberg sign
Echogenic, shadowing calcific or dental (tooth) components
Presence of fluid-fluid levels 5
Multiple thin, echogenic bands caused by hair in the cyst cavity : the dot-dash pattern
Complications
Recognised complications include
Ovarian Torsion : ~ 3-16% of ovarian teratomas on general : considered the most common complication
Rupture : ~ 1-4%
Malignant transformation : ~ 1-2% : usually into squamous cell carcinoma (adults) or rarely into endodermal sinus tumours
(paediatrics).
Suprimposed infection : 1%
Autoimmune haemolytic anaemia : < 1%.
Treatment and prognosis
They are slow growing (1-2 mm a year) and therefore some advocate non surgical management.
Larger lesions are often surgically removed. Many recommend initial serial follow for lesions under 7 cm to monitor growth, beyond
which a resection is advised.
Differential diagnosis
haemorrhagic ovarian cyst
pedunculated lipoleiomyoma of the uterus
ovarian cancer / ovarian serous or mucinous cystadenoma / cystadenocarcinoma
o this is usually only a serious consideration if typical features of mature cystic teratoma are absent (i.e fat is absent)
o tend to occur in an older age group than dermoid cysts

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 48/97
(109). Which of the following is not a method of abdominal tubal ligation?

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 49/97
 a. Irwings method

b. Pomeroy technique

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 50/97
 c. Essure method

d. Parkland method

Solution. Ans-109: (c) Essure method

Ref: Shaws Textbook of Gynecology; Williams Gynecology, 24/e, pg 147; Williams Obstetrics, 24/e, pg 68
Sol:
Essure method is a hysteroscopic method of sterilization.
ESSURE METHOD
Essure method is a newer method of hysteroscopic sterilization.
It was FDA approved in 2002.
The device consists of a microinsert made of a stainless steel inner coil that is enclosed in polyester fibres.
These fibres are surrounded by an expandable outer coil made of Nitinol a nickel and titanium alloy used in coronary artery stents.
The coil is put into the tubal opening using hysteroscope, and after insertion it uncoils.
Fibroblastic proliferation within the fibres causes tubal occlusion.

Advantage
It is an OPD procedure, so minimal or no anaesthesia required and no incision.
Its efficacy is comparable to other methods of sterilization.

Disadvantage
It takes 3 months after the procedure for the tube to get completely blocked and needs to be confirmed with hsg

Methods of sterilization
Laparotomy abdominal incision extends well over 5 cm
o Pomeroy method
o Madlener method
o Irving method
o Aldridge method
o Cornual resection
o Uchida method
o Parkland method
o Fimbriectomy
Minilaparotomy-performed through a small suprapubic incision
Vaginal route
Laparoscopy
Hysteroscopy

1. Pomeroy method -
It is the most popular method of tubal ligation.
The fallopian tube is identified on each side, brought out through the incision and the middle portion is formed into a loop which is
tied at the base with catgut and excised.
Failure rate is only 0.4% and is mainly due to spontaneous recanalization.
The operation is simple, does not require sophisticated and expensive equipment like a laparoscope, and can be performed in
primary health centre by a doctor trained in this procedure.

2. Madlener operation
A loop of tube is crushed and ligated with a non-absorbable suture.
Failure rate is 7%.

3. Irving method
The midportion of the tube is ligated and the intervening portion is excised.
The proximal end is buried in the myometrium and the distal end is buried in the broad ligament.
It is a reliable method, but irreversible.

4. Aldridge method
A hole is made in the anterior leaf of broad ligament and the fimbrial end is buried into this.
It has a high failure rate

5. Cornual resection
The corneal portion of the tube is resected between the clamps.
The technique is complicated, and the uterine end tends to bleed heavily.

6. Uchida method
The tubal serosa is stripped off the muscular layer in the midsegment of the tube, which is then excised.
The proximal end is ligated and buried in the broad ligament.

7. Parkland method
An avascular site in the mesosalpinx adjacent to the fallopian tube is perforated with a small hemostat.
The jaws are opened to separate the fallopian tube from the adjacent mesosalpinx for approximately 2.5 cm.
The freed fallopian tube is ligated proximally and distally with 0-chromic suture.
The intervening segment of approximately 2 cm is excised, and the excision site is inspected for hemostasis.
This method was designed to avoid the initial intimate proximity of the cut ends of the fallopian tube inherent with the Pomeroy
procedure.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 51/97
Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 52/97
(110). Which of the following is not a first line treatment in the management of a 13 year old girl with
abnormal uterine bleeding (anovulatory)?

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 53/97
 a. Mefenamic acid

b. Tranexamic acid

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 54/97
 c. Estrogens

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 55/97
 d. Estrogen + Progesterone pill

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 56/97
 Solution. Ans-110: (c) Estrogens
Ref: Sweet M, Schmidt-Dalton T, Weiss P and Madsen K. Evaluation and Management of Abnormal
Uterine Bleeding in Premenopausal Women. Am Fam Physician. 2012;85(1):35-43
Sol:
TREATMENT OF ABNORMAL UTERINE BLEEDING
(A): Anovulatory bleeding
There is little consensus on specific treatment regimens for anovulatory uterine bleeding.
ACOG recommends treatment with combination oral contraceptives or cyclic progestin.
Progestin therapy and oral contraceptives induce routine withdrawal bleeding, decrease the
risk of hyperplasia or cancer, and correct any related excessive menstrual bleeding.
Oral contraceptives containing 35 mcg or less of ethinyl estradiol are preferred.
Cyclic oral medroxyprogesterone acetate (Provera) at a dosage of 10 mg per day for 10 to 14
days per month also is effective.
Treatment options for women who have hyperplasia without atypia include cyclic
medroxyprogesterone acetate at 10 mg per day for 14 days per month, continuous megestrol
(Megace) at 40 mg per day, or the levonorgestrel-releasing intrauterine system (Mirena).
After the initiation of treatment, endometrial biopsy should be repeated in three to six months
to assure resolution of the hyperplasia.
Because of the high rate of progression to cancer, women found to have hyperplasia with atypia
should be referred to a gynecologist to review treatment options.
Hysterectomy is the recommended treatment, but women desiring continued fertility may be
candidates for progestin therapy and close follow-up.
Women found to have adenocarcinoma should be referred to a gynecologic oncologist for
hysterectomy and staging.

(B): Ovulatory bleeding

The goals of treatment for ovulatory abnormal uterine bleeding (menorrhagia) are to reduce
flow volume and to correct anemia.
Hormonal and non-hormonal therapeutic options are available to patients.
Progestins effectively decrease excessive menstrual bleeding.
In contrast to the shorter course of oral progestin therapy used for anovulatory uterine
bleeding, progestin therapy for menorrhagia needs to be given for 21 days per month to be
effective.
The continuous progesterone release provided by the levonorgestrel-releasing intrauterine
system reduces menorrhagia more effectively than oral progestins.
It is better tolerated than the 21-day oral regimen and has patient satisfaction scores similar to
endometrial ablation and hysterectomy at a significantly lower cost.
The levonorgestrel-releasing intrauterine system is the only contraceptive approved by the U.S.
Food and Drug Administration (FDA) for the treatment of menorrhagia.
Oral contraceptives have been shown to reduce menstrual flow volume, especially when used
continuously, but they have not been studied specifically in women with menorrhagia.
Consequently, there are few data to support their effectiveness.
Oral contraceptives are, however, the treatment of choice in women with known vWD who also
desire contraception.
At scheduled pharmacologic doses, nonsteroidal anti-inflammatory drugs (NSAIDs) decrease
prostaglandin levels, reducing menstrual bleeding.
There is no evidence that one NSAID is more effective than another, but cost varies
considerably.
Tranexamic acid (Lysteda), an antifibrinolytic that prevents activation of plasminogen, is FDA-
approved for the treatment of menorrhagia.
Two 650-mg tablets taken three times per day for the first five days of the cycle decreased
bleeding significantly more than NSAIDs did.
Although increased rates of thrombosis were initially a concern, long-term studies have not
demonstrated this.
Cost remains a limiting factor of tranexamic acid.
It is likely most appropriate in women with bleeding disorders who desire fertility or have
contraindications to oral contraceptives.

SURGICAL TREATMENT
Uterine polyps and leiomyomas, specifically submucosal fibroids, may cause menorrhagia.
Available evidence suggests that hysteroscopic polypectomy reduces 75 to 100 percent of
abnormal uterine bleeding symptoms in women with endometrial polyps.
For menorrhagia associated with submucosal fibroids, surgical resection may allow women to
maintain child-bearing capacity.
Resection may normalize menses, but the clear long-term impact on reproduction is unknown.
Alternatively, fibroids may be treated with uterine artery embolization, the percutaneous
embolization of perifibroid vessels causing infarction of the fibroid.
The effect of uterine artery embolization on future pregnancies also needs further study.
Whether abnormal uterine bleeding caused by fibroids is treated with surgical resection or
uterine artery embolization, approximately 20 percent of women subsequently undergo a
hysterectomy for recurrent abnormal uterine bleeding.
If excessive uterine bleeding is unresponsive to medical intervention, endometrial ablation (the
surgical destruction of the endometrium) may be considered.
This intervention is considered permanent and not advised in women who desire continued
fertility.
By five years postablation, approximately one-third of women require a second operation.
Hysterectomy is the definitive treatment for excessive uterine bleeding in women who no
longer wish to conceive.
Disadvantages include increased number of adverse effects, longer recovery time, and higher
initial health care costs compared with uterine-sparing procedures.
Hysterectomy also may be associated with ovarian failure nearly four years earlier than
expected.

Pharmacological treatment of abnormal uterine bleeding

Drug Dose Comments
Anovulatory bleeding
Provides contraception.
Contraindications
Smokers older than 35
years
Personal history or high
35 g of ethinyl estradiol risk of deep vein thrombosis or
Combined oral contraceptives
monophasic or triphasic pills pulmonary embolism
Multiple risk factors for
arterial cardiovascular disease
History of breast cancer
Severe cirrhosis of liver
Liver cancer
Does not provide contraception.
10 mg per day for 10 14 days
Medroxyprogesterone acetate Caution in patients with severe
per month
hepatic dysfunction.
Endometrial hyperplasia without atypia
Does not provide contraception.
10 mg per day for 10 14 days
Medroxyprogesterone acetate Caution in patients with severe
per month
hepatic dysfunction.
Does not provide contraception.
Megestrol 40 mg per day Caution in patients with severe
hepatic dysfunction.
96% regression rate for
hyperplasia without atypia.
Provides contraception for five
years.
May cause irregular bleeding
or amenorrhea.
Contraindications
Breast cancer
Levonorgestrel releasing
Releases 20 g per 24 hours Uterine anomaly that
intrauterine system (Mirena)
distorts the cavity
Acute pelvic or cervical
infection
Severe cirrhosis of liver
Liver cancer
More expensive initially, but
similar to other therapies when
averaged over five years
Ovulatory bleeding
96% regression rate for
hyperplasia without atypia.
Provides contraception for five
years.
May cause irregular bleeding
or amenorrhea.
Contraindications
Breast cancer
Levonorgestrel releasing
Releases 20 g per 24 hours Uterine anomaly that
intrauterine system (Mirena)
distorts the cavity
Acute pelvic or cervical
infection
Severe cirrhosis of liver
Liver cancer
More expensive initially, but
similar to other therapies when
averaged over five years
Does not provide contraception
Effective short-term therapy for
decreasing heavy flow
10 mg per day for 21 days per Not tolerated as well long term
Medroxyprogesterone acetate
month as levonorgestrel-releasing
intrauterine system
Caution in patients with severe
hepatic dysfunction
NSAIDs
600 to 1200 mg per day, five
Ibuprofen Begin first day of menses and
days per month
continue for five days or until
550 to 1,100 mg per day, five menses ceases.
Naproxen sodium
days per month Treats dysmenorrhea.
Caution in patients with
1,500 mg per day, five days per
Mefenamic acid gastrointestinal risks.
month
DA-approved for menorrhagia
in 2009.
Begin first day of menses and
continue for five days.
Caution in patients with history
or risk of thromboembolic or
650 mg; two tablets three times
Tranexemic acid renal disease.
per day, five days per month
Contraindications
Active intravascular
clotting
Subarachnoid hemorrhage
Considerably more expensive
than other available therapies

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 57/97
 Correct Answer. c

(111). Red degeneration of uterine fibroid in pregnancy is most common in

a. First trimester

b. Second trimester

c. Third trimester

d. Puerperium

Solution. Ans-111: (b) Second trimester

Ref.: Read the text below
Sol :
Red degeneration of uterine fibroid in pregnancy is most common in second trimester.

Correct Answer. b

(112). Polyhydroaminosis is volume of amniotic fluid more than :

a. 1000 ml

b. 2000 ml

c. 3000 ml

d. 4000 ml

Solution. Ans-112: (b) 2000 ml

Ref.: Duttas -213
Sol :
Because the normal values for amniotic fluid volume increase during pregnancy, the actual volume that constitutes polyhydramnios is
dependent on the gestational age of the fetus.
Polyhydramnios usually refers to amniotic fluid volumes greater than 2000 ml.
The range of fluid values diagnostic of oligohydramnios is not as wide as that for polyhydramnios. Less than 200 ml, or when amniotic
fluid index is less than 5 cm, is usually considered to be indicative of oligohydramnios.

Correct Answer. b

(113). With the diagnosis of oligohydramnios, the most important part of the fetal anatomy to evaluate is

a. Heart

b. Lungs

c. Brain

d. Kidneys

Solution. Ans-113: (d) Kidneys

Ref: Read the text below
Sol :
Oligohyramnios is generally defined as an AFI of less than 5.
Amniotic fluid volume decreases relative to the size authors have attempted to define percentiles for gestational age.
Although in this patient, Oligohydramnios is most likely to result from ruptured membranes, It is extremely important to or abnormal
kidneys, as well as obstructive lesions may be responsible for Oligohyramnios.
Bilateral renal agenesisis not compatible with survival.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 58/97
(114). The earliest time in gestation that 90% of healthy fetuses will exhibit fetal heart rate accelerations of 15 beats per minute with fetal
movement is

a. 20-22 weeks

b. 22-24 weeks

c. 26-28 weeks

d. 28-30 weeks

Solution. Ans-114: (c) 26-28 weeks

Ref: Read the text below
Sol :
As gestation advances, the parasympathetic influence becomes dominant.
Heart rate accelerations are observed consistently with fetal movement after about 26-28 weeks gestation in about 90% of fetuses.
Reactivity is most commonly defined as at least two accelerations of the fetal heart rate of 15 beats per minute lasting 15 seconds
observed in a 20 minute monitoring session.

Correct Answer. c

(115). With respect to Downs syndrome screening true is

a. The combined test is more effective than the integrated test

b. The integrated test is more effective than the quadruple test

c. First trimester screening is more effective than second trimester screening

d. The integrated test is performed during the first and second trimesters

Solution. Ans-115: (b) The integrated test is more effective than the quadruple test
Ref: Read the text below
Sol :
DOWN SYNDROME SCREENING
Integrated test
NT and PAPP-A at 10 completed weeks gestation + AFP, free beta-HCG, uE3 and Inhibin-A at 14-20 weeks gestation
Most effective screening test with a false positive rate of 1.2% (1.0 - 1.4) for an 85% detection rate
Combined test
NT, free beta-HCG and PAPP-A at 10 completed weeks gestation
Quadruple test
AFP, uE3, free beta-HCG and Inhibin-A at 14-20 weeks gestation
First trimester screening is as effective as second trimester screening and both are less effective than integrated screening

Correct Answer. b

(116). Which statement is correct for cleavage stage embryo biopsy for pre-implantation genetic diagnosis

a. Requires drilling of the zona pellucid

b. Is by aspiration of 3-4 blastomeres

c. Is facilitated by using culture medium supplemented with calcium and magnesium

d. Is undertaken at the 32 cell stage

Solution. Ans-116: (a) Requires drilling of the zona pellucid

Ref: Read the text below
Sol :
CLEAVAGE STAGE BIOPSY
Undertaken at the 8-10 cell stage, 3 days after fertilization
1-2 blastomeres are aspirated after drilling of the zona pellucid
Drilling may be performed using acid Tyrodes solution, laser or by partial zona dissection

Compaction of the embryo begins to occur after the 8 cell stage with the formation of inter-cellular junctions ? this is Ca2+ / Mg2+
dependent. Biopsy is therefore facilitated by using Ca2+ / Mg2+ free culture medium

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 59/97
(117). In early pregnancy true is

a. A gestation sac can be identified by trans-abdominal scan when HCG >1500IU/L

b. A pseudo-sac is visualised in over 80% of ectopic pregnancies

c. In a normal pregnancy, fetal heart should always demonstrable if CRL > 6mm

d. In a normal pregnancy, fetal heart should always be detectable if sac diameter > 30mm

Solution. Ans-117: (d) In a normal pregnancy, fetal heart should always be detectable if sac diameter > 30mm
Ref: Read the text below
Sol :
EARLY PREGNANCY SCANS
An intra-uterine gestation sac is usually visualised by trans-vaginal scanning at HCG >1500 IU/l and by trans-abdominal scanning at
HCG >6000IU/l
A pseudo-sac is identified in 10-20% of ectopic pregnancies
The Management of Early Pregnancy Loss
1. Ultrasound diagnosis of miscarriage should only be considered with a mean gestation sac diameter >/= 25mm (with no obvious yolk
sac), or with a fetal pole with crown rump length >/=7mm (the latter without evidence of fetal heart activity)
The yolk sac
First detectable on TV scan at ~35 days from LMP at 3-4mm diameter
Maximum diameter reached ~ 10 weeks (6mm)
Compressed against the wall of the chorionic cavity by the expanding amniotic cavity and not detectable after 12 weeks
The embryo
Detectable at ~37 days from LMP by TV scan as a bright linear echo adjacent to the yolk sac. CRL ~2mm and cardiac activity can be
identified
Embryo grows at ~1mm per day

Correct Answer. d

(118). Puerperal pyrexia false is

a. May be due to breast engorgement

b. Secondary to mastitis is usually caused by coliforms

c. Associated with erythema and breast tenderness should be treated with flucloxacillin

d. Embolism is a recognized cause

Solution. Ans-118: (b) Secondary to mastitis is usually caused by coliforms

Ref: Read the text below
Sol :
PUERPERAL PYREXIA
Pyrexia over 38c on 2 occasions after the first 24h post-partum
Causes include endometritis, breast engorgement, mastitis, VTE, perineal abscess, haematoma, thrombophlebitis, wound infections,
UTI, chest infection
Mastitis may occur in the absence of bacterial infection.
Flucloxacillin is the antibiotic of choice as Staph. aureus is the most likely cause

Correct Answer. b

(119). The following are related to LH except

a. Its function is predominantly steroidogenic and to a lesser extent morphogenic

b. It has however no role in maturation of the ovum

c. LH peak precedes progesterone peak

d. Oestrogen peak preceds LH peak

Solution. Ans-119: (d) Oestrogen peak preceds LH peak

Ref.: Read the text below
Sol :
LH stimulates the resumption of meiosis with extrusion of the first polar body shortly before ovulation

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 60/97
(120). Regarding histopathology of cervical cancer

a. Adenoacanthoma means tumour with malignant squamous elements

b. Small cell carcinomas are prognostic ally better.

c. Adenocarcinomas and squamous cell carcinomas are treated similarly

d. In pregnancy adenocarcinomas are common

Solution. Ans-120: (c) Adenocarcinomas and squamous cell carcinomas are treated similarly
Ref.: Read the text below
Sol :
Adenoacanthoma is where tumour is adenocarcinoma with benign squamous metaplasia
Small cell carcinoma has poor prognosis.
In pregnancy squamous tumours are common.

Correct Answer. c

(121). Accurate diagnosis of anencephaly on ultrasound can be done at :

a. 5 weeks of gestation

b. 8 weeks of gestation

c. 10 weeks of gestation

d. 14 weeks of gestation

Solution. Ans-121: (d) 14 weeks of gestation

Ref.: Duttas Obstetrics, 6th ed., p-408
Sol :
In the first of the pregnancy the diagnosis is made by the elevated alfa-fetoprotein in amniotic fluid and confirmed by sonography.
The findings at 13 weeks are :
o Absence of cranial vault
o Angiomatous brain tissue
In the later half of the pregnancy the diagnosis is difficult specially when associated with hydramnios.

Correct Answer. d

(122). True regarding pre-exposure tetanus immunization are all except :

a. If already immunized, a booster in the last trimester is advocated

b. Vaccine is given intramuscularly

c. Tetanus immunoglobulin is injected to the mother

d. 2 doses are recommended

Solution. Ans-122: (c) Tetanus immunoglobulin is injected to the mother

Ref.: Duttas -102
Sol :
Administration of attenuated virus vaccines are contraindicated during pregnancy, the includes vaccines against measles, mumps,
poliomyelitis, rubella, yellow fever, and varicella.
MMR vaccination can be given during lactation and does not affect the baby.
The CDC recommends that non-pregnant women who receive the mmr vaccine or varicella vaccination should wait four weeks before
getting pregnant.
Inactivated bacterial vaccine is used during pregnancy for women who have a specific risk of exposure and disease. Vaccination
against pneumococcus or meningococcus infections, or typhoid fever show no confirmed side effects regarding the fetus.
Tetanus toxoids appear safe during pregnancy and are administered intramuscularly.
0.5 ml tetanus toxoid is given at 6 weeks interval for 2 such, the first one to be given between 16-24 weeks.
Immune globulins are used for post exposure prophylaxis. Such agents are considered in pregnant women exposed to hepatitis B,
rabies, tetanus, varicella, and hepatitis A

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 61/97
(123). Placenta Praevia is characterized by all of the following except :

a. Painless bleeding

b. Causeless bleeding

c. Presents in first trimester

d. Recurrent bleeding

Solution. Ans-123: (c) Presents in first trimester

Ref.: Duttas -245
Sol :
Women with placenta previa often present with painless, bright red vaginal bleeding.
This bleeding often starts mildly and may increase as the area of placental separation increases.
Praevia should be suspected if there is bleeding after 24 weeks of gestation but before 38 weeks.
Abdominal examination usually finds the uterus non-tender and relaxed.
Praevia can be confirmed with an ultrasound

Correct Answer. c

(124). A pregnant lady in her first trimester presents with vaginal bleeding. On examination the os is closed and uterine size corresponds to the
period of amenorrhoea. The condition could be :

a. Septic abortion

b. Complete abortion

c. Inevitable abortion

d. Threatened abortion

Solution. Ans-124: (d) Threatened abortion

Ref.: Duttas -162
Sol :
Threatened abortion The process of abortion has started but has not progressed to a state from which recovery is impossible.
It presents with painless, slight bleeding per vaginum.
Digital examination reveals a closed external os.
Uterine size corresponds to the period of amenorrhoea.

Correct Answer. d

(125). Post term pregnancy is the pregnancy which continues beyond:

a. 274 days

b. 284 days

c. 294 days

d. 304 days

Solution. Ans-125: (c) 294 days

Ref.: Duttas Obstetrics -318
Sol :
The normal duration of pregnancy is approximately 37 to 42 weeks, with the estimated due date at 40 weeks or 280 days from the first
day of the last menstrual period.
A postterm pregnancy/prolonged pregnancy/post maturity is one that has extended beyond 2 weeks of the expected date of delivery
(beyond 294 days.)
Nearly 10 percent of pregnancies are post term.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 62/97
(126). Drug of choice for endometriosis in a young lady with infertility :

a. Danazol

b. GnRH analogue

c. Clomiphene citrate

d. Progesterone

Solution. Ans-126: (c) Clomiphene citrate

Ref.: Read the text below
Sol :
The efficacy of the hormone therapy in t he management of endometriosis is judged by relief of symptoms, reduction of the size of the
lesions as revealed by second look laparoscopy, improvement off fertility and prevention of recurrenc.
Drug of choice for endometriosis in a young lady with infertility is Clomiphene citrate
For quick relief of symptoms and reduction of the size of the lesion, GnRH analogues are the best (only drawback is that its bit
expensive).
Progestogens take some time to achieve these objectives. In fact, initially there may be aggravation of the symptoms.
Danazol is placed midway between the two.

Correct Answer. c

(127). Pseudo-Meigs syndrome meet all of the criteria except :

a. Pleual effusion

b. Potential for ovarian malignancy

c. Ascitis

d. Ovarian fibroma

Solution. Ans-127: (d) Ovarian fibroma

Ref.: Read the text below
Sol :
Pseudo-Meigs syndrome is a rare syndrome with pelvic tumors like uterine/broad ligament fibroids, leiomyoblastoma of colon. CA
ovary etc. (and not ovarian fibromas), which is combined with ascites and hydrothorax.
Pseudo-Meigs syndrome is sometimes associated with elevated CA-125
Meigs syndrome on the other hand is defined as the presence of ascites hydrothorax associated with a benign ovarian tumor that
disappears after the removal of the tumor.
Joe Vincent Meigs (1892-1963), a professor of the Harvard Medical School of Gynecology drew attention to the syndrome, however it
had been described previously by numerous authors in the nineteenth century and beginning the twentieth. In 1937 Meigs and Cass
alerted he medical profession on the importance of the syndrome. Finally, in the same year, Rhodes and Terrell denominated it Meigs
syndrome.

Correct Answer. d

(128). Weid Reiner test is for :

a. Abruptio placentae

b. Threatened abortion

c. Marginal sinus

d. Vasa previa

Solution. Ans-128: (a) Abruptio placentae

Ref.: Read the text below
Sol :
This test was done to show the cause of severe bleeding in accidental hemorrhage.
The studies of Weiner, Reid, Roby and many others have shown that in severe cases of accidental hemorrhage there is a depletion of
blood fibrinogen resulting in hypofibrinogenemia or even in afibrinogenemia (the so-called acute or even in afibrinogenemia (the so-
called acute defibrination syndrome) attention to which had been drawn by Deickman years ago.
This lack of fibrinogen results in incoagulable blood and hence severe bleeding.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 63/97
(129). A 30-year-old multigravida presented with transverse lie with hand prolapse in IInd stage of labor with dead fetus. The treatment of
choice is:-

a. Craniotomy

b. Decapitation

c. Cleidotomy

d. Wait & watch

Solution. Ans-129: (b) Decapitation

Ref: Read the text below
Sol:

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 64/97
(130). A woman, gravid 0, para 0,underwent infertility evaluation. The infertility was diagnosed as being secondary to an ovulation because of
polycystic ovary syndrome. Which of the following statements is most likely to be true?

a. She has a low body mass index

b. She has evidence of virilization

c. Androgen production is primarily from adrenals

d. Gonadotropins are tonically elevated

Solution. Ans-130: (d) Gonadotropins are tonically elevated

Ref:Read the text below
Sol:
The underlying mechanism in polycystic ovary syndrome is a tonically elevated luteinizing hormone (LH) level that results in absence
of normal menstrual hormone fluctuations.
The body mass index is usually high, not low. Although hirsutism is common, virilization is not seen.
The androgen production is largely from the ovary, rather than the adrenals.

Correct Answer. d

(131). Treatment for a women suffering from Antiphospholipid antibody syndrome (APL) with past history of stillbirths and abortion is

a. Aspirin only

b. Low dose Aspirin + LMW heparin

c. Start Low dose Aspirin + LMW heparin + Prednisolone

d. No treatment

Solution. Ans-131: (b) Low dose Aspirin + LMW heparin

Ref:Read the text below
Sol:
Combined unfractionated heparin and low-dose aspirin regimens are thought to reduce the risk of spontaneous pregnancy loss by
54%, resulting in a live-birth rate of 70-80%.
Evidence from small, controlled trials (25-50 patients) has suggested that patients with recurrent pregnancy loss associated with
antiphospholipid antibodies and without prior thromboembolism benefit from treatment with low-dose unfractionated heparin at
prophylactic doses of 5,000-10,000 IU twice daily, in addition to low-dose aspirin at 70-81 mg daily.

Correct Answer. b

(132). A small-for-gestational-age newborn has hepatosplenomegaly, thrombocytopenia, hepatitis, jaundice, cataracts, and a Blueberry muffin
rash. Which of the following is the most likely cause of these findings?

a. Toxoplasmosis

b. Rubeola

c. Rubella

d. Varicella

Solution. Ans-132: (c) Rubella

Ref:Read the text below
Sol:
Congenital rubella syndrome occurs after German measles in infection during pregnancy and causes a variety of congenital
malformations.
These manifestations may include hepatosplenomegaly, thrombocytopenia, hepatitis, jaundice, cataracts, a blueberry muffin rash,
and neurologic depression.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 65/97
(133). Nuchal translucency at 14 weeks of gestation is increased in

a. Turner syndrome

b. Down syndrome

c. Hydrocephalus

d. Skeletal dysplasia

Solution. Ans-133: (b) Down syndrome

Ref: NMS Obstetrics and Gynecology, 6th Edition-52
Sol:
The American College of Obstetricians and Gynecologists (ACOG) has recently recommended that screening for Down syndrome
should be offered to all pregnant women regardless of their age.
First-trimester screen in the form of ultrasound for nuchal translu-cency (NT) plus biochemical markers such as pregnancy-
associated plasma protein A (PAPP-A) and free -hCG have a detection rate for Down syndrome of 84%.
Second-trimester screen consisting of multiple marker screen (quadruple screen) consists of MSAFP, unconjugated estriol, hCG, and
inhibin A.
This screen has a detection rate of 81%. Pregnancies affected with Down syndrome usually have a low MSAFP, low estriol, high
HCG, and high inhibin A.
Individualized counseling should be offered to patients to determine the best screening strategy and the need for further invasive
testing in the form of chorionic villi sampling (CVS) or genetic amniocentesis.

Correct Answer. b

(134). Organisms commonly isolated in cases of Chorioamnionitis include all of the following except:

a. Streptococcus agalactiae

b. Bacteroides fragilis

c. Peptostreptoccoccus

d. Neisseria gonorrhoea

Solution. Ans-134: (d) Neisseria gonorrhoea

Ref: Read the text below
Sol :
Chorioamnionitis is caused by many different organisms, including aerobic and microaerophilic streptococci, aerobic gram negative
rods, and various anaerobes including Bacteroides bivis, and peptostreptococcus.
Gardnerella vaginalis, alone and in combination with other anaerobes has been implicated as a cause of premature rupture of
membranes and Chorioamnionitis.
This is the organism frequently identified although not the sole etiology of bacteria vaginosis.

Correct Answer. d

(135). The probability of a term infant being infected when the mother has Chorioamnionitis is about

a. 5%

b. 15%

c. 25%

d. 50%

Solution. Ans-135: (a) 5%

Ref: Read the text below
Sol :
Interestingly, the correlation between maternal and fetal infection is poor, with only about 5% of fetuses being infected, even in the
context of clinical Chorioamnionitis.
The incidence of neonatal sepsis is higher if the infecting organism is either GBS or E. coli.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 66/97
(136). Which of The following are indications for delivery in a woman with pre-eclampsia at 30 weeks gestation

a. Hypertension controlled on two drugs

b. 24 hour urine protein excretion of 3g

c. Hyperreflexia

d. Development of HELLP syndrome

Solution. Ans-136: (d) Development of HELLP syndrome

Ref: Read the text below
Sol :
PRE-ECLAMPSIA
Indications for delivery
Term fetus
Fetal distress / compromise (IUGR with abnormal Dopplers - gestation age dependent)
Eclampsia
Uncontrollable hypertension
Maternal symptoms - severe headache / epigastric pain
Rapidly deteriorating haematological / biochemical indice
HELLP syndrome

Correct Answer. d

(137). 34 year old primigravida presents with abdominal pain and uterine contractions at 33 weeks gestation. Which is incorrect for her
management

a. Corticosteroids should be administered

b. Tocolytics should be administered

c. Erythromycin should be prescribed

d. The presence of a normal fetal heart rate does not excludes concealed abruption

Solution. Ans-137 : (c) Erythromycin should be prescribed

Ref: Read the text below
Sol :
THREATENED PRE-TERM LABOUR
Corticosteroids and tocolytics are recommended - improve perinatal outcome
Erythromycin is not associated with improved outcome in threatened pre-term labour with intact membranes
Fetal heart would be normal in mild concealed abruption

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 67/97
(138). What is the name of the procedure shown here, used to resolve head entrapment ?

a. Symphysiotomy

b. Pinard maneuver

c. Duhrseen incisions

d. Zavanelli maneuver

Solution. Ans-138 : (c) Duhrseen incisions

Ref: Read the text below
Sol :
Duhrseen incisionsimply three surgical incisions of an incompletely dilated cervix, corresponding roughly to 2-, 6-, and 10-o'clock, used
as a means of effecting immediate delivery of the fetus when there is an entrapped head during a breech delivery

Correct Answer. c

(139). If this patient is diagnosed with gestational diabetes, her chance of developing impaired glucose tolerance or Type II diabetes within the
next 20 years is about

a. 10%

b. 20%

c. 30%

d. 50%

Solution. Ans-139: (d) 50%

Ref: Read the text below
Sol :
GDM is associated with an increased risk in the mother for cesarean section or other operative delivery (forceps), delivery of a
macrosomic or large for gestational age (LGA) infant, shoulder dystocia and ultimately developing impaired glucose tolerance to Type II
diabetes (approximately a 50% risk after 20 years.)
The infant of a mother with GDM is not at hypocalcaemia, hyperbilirubinemia and polycythemia.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 68/97
(140). A 67-year-old woman presents with intense pruritus of the vulva. On examination, the vaginal introitus is stenotic, with the skin
appearing thin, wrinkled, and parchment-like. Which of the following treatments is most appropriate?

a. 5-Fluorouracil

b. Testosterone cream

c. Fluorinated corticosteroids

d. Miconazole

Solution. Ans-140 : (b) Testosterone cream

Ref:Read the text below
Sol:
The lesion described is that of lichen sclerosis. The key finding is the atrophic skin description. The treatment of choice is testosterone
cream.
5-Fluorouracil is used for neoplasias.
Fluorinated corticosteroids are indicated for hyperplastic dystrophies of the vulva.
Miconazole is an antifungal agent

Correct Answer. b

(141). Non-immune hydrops fetalis is caused by

a. CMV

b. Parvovirus

c. HPV

d. HBV

Solution. Ans-141 : (b) Parvovirus

Ref: NMS Obstetrics and Gynecology, 6th Edition-77
Sol:
Parvovirus B19 is the cause of erythema infectiosum, otherwise known as fifth disease or slapped cheek disease.
This virus can trigger fetal aplastic anemia, which can lead to congenital heart failure and hydrops fetalis.

Correct Answer. b

(142). Which of the following tests on maternal serum is most useful in distinguishing between open neural tube defects and ventral wall
defects in a fetus?

a. Carinoembryogenic antigen

b. Sphingomyelin

c. Alpha-feto protein

d. Pseudocholinesterase.

Solution. Ans 142: (d) Pseudocholinesterase.

Reference: Read the text below
Sol:
Pseudocholinesterase measurement on maternal serum is most useful in distinguishing between open neural tube defects and
ventral wall defects in a fetus

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 69/97
(143). Chorionic villous sampling done before 10 weeks may result in

a. Fetal loss

b. Fetomaternal hemorrhage

c. Oromandibular limb defects

d. Sufficient material not obtained

Solution. Ans 143: (c) Oromandibular limb defects

Reference: Read the text below
Sol:

Chorionic villous sampling is usually performed at 10-13 weeks and is associated with several complications but studies suggests
that limb reduction and oromandibular limb hypogenesis is more common if VCS is done before 9 weeks.
So, CVS is done after 9 weeks because it is more safe.

Correct Answer. c

(144). Lymphatic drainage of the vulva occurs by all of the following lymph nodes, except:

a. Inferior gluteal lymph nodes

b. Superficial femoral lymph nodes

c. Internal iliac lymph nodes

d. Ext. iliac lymph nodes.

Solution. Ans144: (a) Inferior gluteal lymph nodes.

Ref: Read the text below
Sol:
Lymphatic drainage of vulva - internal iliac,external iliac and superficial femoral nodes.
Inferior gluteal nodes - receives lymph drainage from cervix, the lower portion of the vagina and Bartholin's glands;

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 70/97
(145). Isolated marker of Neural Tube defects is

a. Acetylcholinesterase

b. Pseudocholinesterase

c. AFP

d. Decreased hCG

Solution. Ans-145: (a) Acetylcholinesterase

Ref:Read the text below
Sol:
Neural tube defects (NTDs) are a group of disorders that arise early in fetal development and can cause life-long complications of
varying severity.
During the first 3-4 weeks of development, specific cells in an embryo curl up and their edges fuse together to form a narrow tube
that becomes the foundation of the spinal cord, brain, and the bone and tissues that surround it.
This neural tube fusing process usually is complete by 28 days of gestation before many women even know that they are pregnant. If
the tube does not close properly along its entire length, then a NTD will form at the open location

Laboratory Tests
Laboratory tests may include:
Triple screen or Quad screen - this group of tests is performed on the mother during her 2nd trimester and includes an AFP (alpha-
fetoprotein) test. Increased levels of AFP have been associated with an increased risk of an open NTD.
AFP and acetylcholinesterase in amniotic fluid. If the serum AFP is elevated, AFP and acetylcholinesterase can be measured in
amniotic fluid, as confirmatory tests. A fetal karyotype test may also be done on the fluid to rule out chromosomal abnormalities. These
tests are followed by or performed with a fetal ultrasound.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 71/97
(146). A 19-year-old woman, gravid 2, para 0, abort 1, is at 30 weeks gestation. Her fundal height measures 25cm. An obstetrical ultrasound
examination reveals a 4 quadrant amniotic fluid index (AFI) of 4cm. Which of the following fetal conditions is associated with finding?

a. Duodenal atresia

b. Open spina bifida

c. Tracheoesophageal fistula

d. Renal agenesis

Solution. Ans-146: (d) Renal agenesis

Ref:Read the text below
Sol:
The case describes oligohydramnios, or decreased amniotic fluid. Marked deficiency in amniotic fluid volume may occur with
decreased production or excessive removal of fluid.
A serious consequence of oligohydramnios, regardless of etiology, is umbilical cord compression leading to fetal hypoxia.
The only option of the provided that leads to oligohydramnios is renal agenesis.

Correct Answer. d

(147). The contraindication of injection PGF2 is -

a. Cardiovascular disease

b. Uterine scar

c. Peptic ulcer

d. Hypertension

Solution. Ans-147 : (b) Uterine scar

Ref: Read the text below
Sol:
PGF2a is synthesized by decidua in vivo, it promotes myometrial contractility. The main obstetric uses of this compound are
induction of abortion (MTP and missed abortion) and management of atonic PPH.
The contraindications are hypersensitivity to the compound and uterine scar. PGF2a acts predominantly on myometrium.
The unpleasant side effects are nausea, vomiting, diarrhea, pyrexia or bronchospasm but the symptoms subside promptly due to
rapid metabolism of PGs.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 72/97
(148). All of the following are associated with breech presentation at normal full term pregnancy, except:

a. Placenta accreta

b. Fetal malformation

c. Uterine anomaly

d. Cornual implantation of placenta

Solution. Ans-148: (a) Placenta accreta

Ref: Read the text below
Sol:
Causes of breech presentation :
1.Prematurity is the commonest cause of breech presentation.
2. Factors preventing spontaneous version.
(a) Twins
(b) Oligohydramnios
(c) Breech with extended legs
(d) Congential malformation of uterus such as septate or bicornuate uterus
(e) Short cord
(f) Intrauterine death of the fetus/fetal malformations.
3. Favourable adaptation :
(a) Hydrocephalus
(b) Placenta praevia
(c) Cornufundal attachment of the placenta
(d) Contracted pelvis
4. Undue mobility of the fetus :
(a) Hydramnios
(b) Multiparae with lax abdominal wall

Correct Answer. a

(149). "Decapitation" is an indication for-

a. Shoulder dystocia

b. Neglected shoulder presentation with dead fetus

c. Large hydrocephalus

d. Cephalic presentation with obstructed labour with dead fetus

Solution. Ans-149: (b) Neglected shoulder presentation with dead fetus

Ref: Read the text below
Sol:
Decapitation is a destructive operation whereby the fetal head is severed from the trunk and delivery is completed with the
extraction of trunk and that of decapitated head per vaginum.
It is indicated in neglected shoulder presentation with dead fetus where neck is easily accessible.
For shoulder dystocia Cleidotomy may be done when baby is dead.
For hydrocephalus Craniotomy can be performed which is also an indication for cephalic presentation with obstructed labour when
fetus is dead.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 73/97
(150). Male infertility is due to following factors :-

a. Varicocele

b. Chronic epididymitis

c. Sperm motility less than 50%

d. All of the above

Solution. Ans-150 : (d) All of the above

Ref: Read the text below
Sol:
Normal sperm parameters are :-
Liquification in 30 minutes
Volume 2-5 ml
pH - 7.2 - 7.8
Fructose present
Sperm count 20-250 millions per ml. (Average 80-120 million/ml)
Sperm motility > 50% grade III and > 50% sperm of normal morphology.
Varicocele is varicosity of the pampiniform plexus. The diagnosis is confirmed by Doppler studies.
It is treated by high ligation of spermatic vein (Palomo's operation) or excision of the plexus.

Correct Answer. d

(151). Beta hCG test in urine in case of ectopic pregnancy:-

a. Always positive

b. Weakly positive

c. May or May not be positive

d. Equivocal

Solution. Ans-151: (c) May or May not be positive

Ref: Read the text below
Sol:
Beta hCG production is below normal level in ectopic gestation: Even absence of amenorrhea or negative
Beta hCG test in early gestation does not rule out ectopic pregnancy. Ultrasound is of great help in diagnosis.

Correct Answer. c

(152). Circumvallate placenta causes which of the following ?

a. Abruptio placenta

b. Is recognized as a white ring within the placenta on the fetal surface

c. IUGR fetus

d. All of the above

Solution. Ans-152: (d) All of the above

Ref: Read the text below
Sol:
IUGR is caused by placental insufficiency, and abruptio is caused by placental separation at its margin.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 74/97
(153). Preconception supplement of folic acid to woman :-

a. Minimize foetal neural tube defect

b. Help to conceive faster

c. Minimize iron deficiency anemia

d. Prevents ectopic pregnancy

Solution. Ans-153: (a) Minimize foetal neural tube defect

Ref: Read the text below
Sol:
Preconception supplement requires in elderly women (above 29 years), women with history of congenital birth defects.
Folic acid (5 mg BD) supports ovum and improves quality of egg.

Correct Answer. a

(154). The drug of choice for ovulation induction in a 28 years old infertile patient with polycystic ovarian syndrome (PCOS) is

a. GnRH analogues

b. Gonadotrophins

c. Clomiphene citrate

d. Metformin

Solution. Ans-154: (c) Clomiphene citrate

Ref: Read the text below
Sol:
Clomiphene citrate is the drug of choice in PCOS patient for ovulation induction.
Gonadotrophins are 2nd line drugs because chances of ovarian hyperstimulation syndrome are more with gonadotrophins
particularly in PCOS.
Metformin is an adjuvant drug particularly in patients with features of insulin resistance.

Correct Answer. c

(155). For delivery of preterm baby, to cut short the II stage of labour, one of the following may be indicated-

a. Ventouse

b. Forceps

c. Both

d. None

Solution. Ans-155: (b) Forceps

Ref: Read the text below
Sol:
It is necessary to cut short the II stage of labour in case of delivery of preterm baby because these babies are prone to
intraventricular haemorrhage.
Forceps act as protective cage for preterm head.
Ventouse is contraindicated in these because chance of scalp avulsion and subaponeurotic haemorrhage is more.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 75/97
(156). Battledore insertion of the umbilical cord means:-

a. Insertion of the cord at the periphery of the placenta

b. Cord insertion in the membranes away from the placenta

c. Cord insertion half-way between the centre and periphery of the placenta

d. None of the above

Solution. Ans-156: (a) Insertion of the cord at the periphery of the placenta
Ref: Read the text below
Sol:
Battledore insertion of the umbilical cord means Insertion of the cord at the periphery of the placenta
Cord insertion in the membranes away from the placenta is associated with velamentous insertion of the cord, and vasa praevia.

Correct Answer. a

(157). Following is a class A FDA drug used in pregnancy:-

a. Methyl dopa

b. Aspirin

c. Heparin

d. All of the above

Solution. Ans-157: (d) All of the above

Ref: Read the text below
Sol:
Other class A FDA drugs are penicillin - cephalosporin, Erythromycin - clindamycin. They have no teratogenicity.
FDA B drugs are antihistamines, Decongestants. They showed no evidence of risk in humans. FDA C :- Risk can not be ruled out.
These drugs are metronidazole, Ciprofloxacin, Amino glycosides.
FDA D:-Positive evidence of risk like Carbamazepine, Valproic acid, alcohol, Warfarin. FDA X:- Contraindicated in pregnancy like
Tetracycline, Doxycycline, and Minocycline.

Correct Answer. d

(158). The false statement about morning sickness :-

a. Diagnostic of pregnancy

b. Due to high level of hCG in circulation

c. It is a self limiting disorder, which rarely continues beyond the first trimester

d. Treated with anti-histamines & pyridoxine supplements

Solution. Ans-158: (a) Diagnostic of pregnancy

Ref: Read the text below
Sol
MORNING SICKNESS
Due to high level of hCG in circulation
It is a self limiting disorder, which rarely continues beyond the first trimester.
Treated with anti-histamines & pyridoxine supplements
Gestational sac on ultra sound is sure diagnostic test of pregnancy.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 76/97
(159 If lifestyle factors are identified, the changes leading to improved chances of
). fertility are all except

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 77/97
 a. Lose weight

b. Gain weight

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 78/97
 c. Vegetarian diet

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 79/97
 d. Less exercise

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 80/97
 Solution. Ans-159: (c) Vegetarian diet
Ref: http://www.acog.org/Patients/FAQs/Treating-Infertility
Sol:
ACOG clarifies some frequently asked questions (FAQs) regarding infertility
and its treatment.
What is infertility?
Infertility is defined as not having become pregnant after 1 year of having
regular sexual intercourse without the use of birth control.
Infertility can be caused by a number of factors.
Both male and female factors can contribute to infertility.
What treatment options are available for infertility?
Treatment options depend on the cause of your infertility.
Lifestyle changes, medication, surgery or assisted reproductive
technology (ART) may be recommended.
Several different treatments may be combined to improve results.
Infertility often can be successfully treated even if no cause is found.
What lifestyle changes may help improve my chances for pregnancy?
If lifestyle factors are identified, you may need to lose or gain weight or
do more or less exercise.
You or your male partner may need to reduce your intake of alcohol, quit
smoking, or stop using illegal drugs.
How is surgery used to treat infertility in women?
In women, surgery may be able to repair blocked or damaged fallopian
tubes.
Surgery is used to treat endometriosis, which is commonly associated
with infertility.
How is surgery used to treat infertility in men?
In men, surgery can be used to treat some infertility problems.
A common problem that leads to male infertility, varicocele, sometimes
can be treated with surgery.
How are hormonal problems treated in women?
Abnormal levels of hormones can cause irregular ovulation or lack of
ovulation.
For example, polycystic ovary syndrome is a condition in which the levels
of certain hormones are abnormal and menstrual periods are irregular or
absent.
It is a common cause of infertility.
This condition often is treated with lifestyle changes or medication.
Progesterone may be used to treat some ovulation problems.
Other hormonal conditions that affect fertility in women, such as thyroid
disease, should be ruled out.
What is ovulation induction?
Ovulation induction is the use of drugs to induce a womans ovaries to
release an egg.
This treatment is used when ovulation is irregular or does not occur at all
and other causes have been ruled out.

How is ovulation induction done?

The drug most commonly used for ovulation induction is clomiphene
citrate.
About 40% of women achieve pregnancy with the use of this drug within
six menstrual cycles.
Side effects usually are mild and include hot flashes, breast tenderness,
nausea, and mood swings.
What drugs other than clomiphene citrate are used for ovulation induction?
If clomiphene citrate is not successful, drugs called gonadotropins may be
tried to induce ovulation.
Gonadotropins also are used when many eggs are needed for ART or
other infertility treatments.
This is called super ovulation.
How are gonadotropins used?
Gonadotropins are given in a series of shots early in the menstrual cycle.
Blood tests and ultrasound exams are used to track the maturation of the
follicles (small sacs in which eggs develop).
When test results show that the follicles have reached a certain size,
another drug called human chorionic gonadotropin (hCG) may be given.
This drug triggers ovulation.
What risks are associated with ovulation induction?
Twins occur in about 10% of women treated with clomiphene citrate.
Triplets or more are rare.
The risk of multiple pregnancy is higher when gonadotropins are used.
Up to 30% of pregnancies conceived with gonadotropins are multiple.
About two thirds of these pregnancies are twins and one third are triplets
or more.
Ovulation induction can lead to ovarian hyperstimulation syndrome.
Most cases of this condition are mild.
In severe cases, hospitalization may be needed.
What is intrauterine insemination?
In intrauterine insemination, a large amount of healthy sperm is placed in
the uterus as close to the time of ovulation as possible.
It often is used with ovulation induction or super ovulation.
The womans partner or a donor may provide the sperm.
Sperm that has been retrieved earlier and frozen also can be used.
What are the risks of intrauterine insemination?
If ovulation drugs are used with intrauterine insemination, multiple
pregnancy can occur.
If too many eggs are developing at the time of insemination, the
insemination may be canceled.
What is assisted reproductive technology (ART)?
ART includes all fertility treatments in which both eggs and sperm are
handled.
ART usually involves in vitro fertilization (IVF).
In IVF, sperm is combined with the egg in a lab, and the embryo is
transferred to the uterus.
IVF is done for the following causes of infertility:
o Damaged or blocked fallopian tubes that cannot be treated with surgery
o Some male infertility factors
o Severe endometriosis
o Premature ovarian failure
o Unexplained infertility

How can I find out ART success rates?

The Centers for Disease Control and Prevention reports this information
on its web site (www.cdc.gov/reproductivehealth/ index.htm).
Success rates also are listed on the web site of the Society for Assisted
Reproductive Technology (SART) (www.sart.org).

How is in vitro fertilization (IVF) done?

IVF is done in cycles.
It can take more than one cycle to succeed.
The sperm may come from your partner or from a donor.
Sperm can be retrieved and then frozen for later use in IVF.
Ovulation usually is induced with gonadotropins so that many eggs are
produced.
The egg also may come from a donor.
Eggs that have been previously frozen can be used.
Eggs are removed from the ovaries when they are mature.
Healthy sperm then are added to the eggs in the lab.
The eggs are checked the following day to see if they have been fertilized.
A few days later, one or more embryos are placed in your uterus.
The embryo may come from a donor.
Healthy embryos that are not transferred can be frozen and stored for
later use.

What is intracytoplasmic sperm injection (ICSI)?

Sometimes, a single sperm may be injected into each egg.
This is called ICSI.
ICSI may be recommended if there is a problem with your partners
sperm.
In ICSI, only a single healthy sperm is needed for each egg.
A few days later, one or more embryos are placed in the uterus through
the vagina.

What are the risks associated with IVF?

There is an increased risk of multiple pregnancy with IVF.
IVF also has been linked to an increased risk of birth defects.
These defects include cleft palate, heart problems, and problems with the
digestive tract.
Overall, however, the increase in risk of birth defects is small.

What steps can be taken to help prevent multiple pregnancy with IVF?
Several things can be done to help prevent multiple pregnancy.
If test results suggest that too many eggs are developing, the hCG shot
that triggers ovulation may be delayed or not given.
Your doctor also may limit the number of embryos transferred to your
uterus.

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 81/97
 Correct Answer. c

(160). A 22 years old Grand multi para present with cord prolapse, following statement is true except:-

a. First aid M/M is to lift the presenting part of the cord.

b. Knee chest position to relieve pressure over the cord.

c. A loop of cord may be brought down for better palpation to confirm the pulsation

d. Foetus may be alive even in the feeble cord pulsation

Solution. Ans-160: (c) A loop of cord may be brought down for better palpation to confirm the pulsation.
Ref: Read the text below
Sol:
The cord should not be pulled down as handling the cord or exposure to air may produce vasospasm.
If baby is alive or cord pulsation present emergency LSCS to be done with neonatal resuscitation.
Cord prolapse seen in floating head, polyhydramions, twins, long cord

Correct Answer. c

(161). Which of the following is not the high risk for an ectopic pregnancy ?

a. Previous ectopic pregnancy

b. Previous tubal surgery

c. IUCD user

d. Oral combined pills

Solution. Ans-161: (d) Oral combined pills

Ref: Read the text below
Sol:
By suppressing ovulation oral contraceptive pills, do not predispose to an ectopic pregnancy.
(1), (2), (3) by causing damage to the tube or narrowing its lumen can conduce to an ectopic pregnancy.
IUCD causes PID and predisposes to an ectopic pregnancy

Correct Answer. d

(162). A 35 year old, gravida 5, present with obstructed labour. Management would be all except :-

a. There is no place of wait, watch policy

b. Dehydration, ketoacidosis should be promptly corrected.

c. Emergency LSCS has to be done to prevent rupture uterus & save the baby.

d. Oxytocin drip should be given for acceleration of labour pains

Solution. Ans-162: (d) Oxytocin drip should be given for acceleration of labour pains.
Ref: Read the text below
Sol:
Oxytocin has got no role in management of obstructed labour as it may potentially enhance rupture of uetrus. PPH should be
management by prostadines. Methylergometrine & oxytocin can be given after delivery of baby.
Obstructed labour is seen in Malpresentation, Grand Multi para, injudicious use of oxytocin for acceleration of labour pains and deep
transverse arrest of head. Uterus should be explored as a routine following delivery.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 82/97
(163). Advantages of median episiotomy over mediolateral episiotomy are all except :

a. Less blood loss

b. Easy repair

c. Extension of the incision is easy

d. Muscles are not cut

Solution. Ans-163: (c) Extension of the incision is easy

Ref.: Read the text below
Sol :
Mediolateral episiotomy is performed by making a diagonal incision across the midline between the vagina and anus
This method is used much less often.
The disadvantages are :
o Apposition of the tissues is not so good.
o May require more healing time than the midline incision.
o Blood loss is little more
o Post operative discomfort is more
o Relative increased incidence of wound disruption
o Dysparenunia is comparatively more
The advantages are :
o If necessary the incision can be extended.
o Relative safety from rectal involvement from extension.

Correct Answer. c

(164). Progress of the labour is assessed with the help of

a. Cervicograph

b. Partogram

c. Dilatation chart

d. Growth curve

Solution. Ans-164: (b) Partogram

Ref.: Duttas -529
Sol :
The partogram is a series of charted measurements which are used to assess the progress of labour.
Partograms are designed to encourage a universal manner of dealing with labour and to give an early, easy way of recognizing
problems in labour.
Information recorded includes :
o Maternal BP (2 hourly) , heart rate (half hourly), temperature (once unless abnormal), Contractions length, frequency, strength.
o Baby heart rate (2 hourly)
o State of membranes and colour of liquor.
Also maternal state of mind, drugs administered etc.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 83/97
(165). Bishops classification is used for :

a. Progress of labour

b. Requirement of induction for labour

c. Gestational age of fetus

d. Fetal well being

Solution. Ans-165 : (b) Requirement of induction for labour

Ref.: Duttas -522
Sol :
Bishop score, also Bishop's score, is a pre-labour scoring system to assist in predicting whether induction of labour will be required. It
has also been used to assess the odds of spontaneous preterm delivery
The total score is achieved by assessing the following five components on vaginal examination: The Bishop score grades patients who
would be most likely highly to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score; a score
that exceeds 8 describes the patient most likely to achieve a successful vaginal birth. Bishop scores of less than 6 usually require that a
cervical ripening method be used before other methods.
Cervical dilation
Cervical effacement
Cervical consistency
Cervical position
Fetal station

Correct Answer. b

(166). A hypertensive primigravida with completely subsided pre-eclamptic features, pregnancy should be continued at least upto :

a. 35 week

b. 37 week

c. 39 week

d. 40 week

Solution. Ans-166: (b) 37 weeks

Ref.: Duttas -230
Sol :
If the pre-eclamptic features are completely controlled :
o If the duration of the pregnancy is remote far from term, she should be discharged with the advice to attend antenatal clinic s
regularly.
o If the patient is near term, she should be kept for a few days till completion of 37th week.
o If the pre-eclamptic features are partially controlled but BP maintains a steady high level then :
o If pregnancy is beyond 37 completed weeks, termination is be considered without delay.
o If less than 37 weeks, then expectant treatment may be extended judiciously at least upto 34 weeks.

Correct Answer. b

(167). Which of the following is seen in 2nd stage of labor :

a. Expulsion of the fetus

b. Increase in contraction

c. Cervical dilatation

d. All of the above

Solution. Ans-167: (a) Expulsion of the fetus

Ref.: Duttas -122
Sol :
Second stage (expulsion) begins when the cervix if fully dilated, and ends when the baby is finally born.
At the beginning of the normal second stage, the head is fully engaged in the pelvis;the widest diameter of the head has successfully
passed through the pelvic brim.
Ideally it has successfully also passed below the interspinous diameter. This is the narrowest part of the pelvis.
The volume of the uterine cavity is reduced and uterine contractions and retraction becomes stronger.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 84/97
(168). A full-term multigravida is having breech presentation. Ideal management in this case would be :

a. Elective caesarean section

b. External cephalic version followed by vaginal delivery

c. Trial of labour

d. External cephalic version followed caesarean section

Solution. Ans-168: (b) External cephalic version followed by vaginal delivery

Ref.: Duttas -382
Sol :
Indications for Elective caesarean section in breech presentation :
o Estimated fetal weight more than 3.5 kg
o Hyper extended head
o Footling presentation
o Associated complications
o Pelvic inadequacy

Correct Answer. b

(169). External cephalic version is contraindicated all of the following except

a. Antepartum hemorrhage

b. Multiple pregnancy

c. Breech presentation

d. Ruptured membranes

Solution. Ans-169: (c) Breech presentation

Ref.: Duttas -380
Sol :
External cephalic version is a process by which a breech baby can sometimes be turned from buttocks or foot first to head first. It is
usually performed after about 36 weeks.
It is often reserved for late pregnancy because breech presentation greatly decreases with every week.
It can be contrasted with interal cephalic version, which involves the hand inserted through the cervix
Contraindications include antepartum hemorrhage, pre-eclampsia, ruptured membranes, uterine scarring, and multiple pregnancies or
fetal abnormality.

Correct Answer. c

(170). True labour pains is represented by :

a. Pain and discomfort in the abdomen

b. Show

c. Relieved by enema ans administration of sedative

d. Dull in nature

Solution. Ans-170: (b) Show

Ref.: Duttas Obstetrics, 6th ed., p-117
Sol :
Features of true pain :
o Painful uterine contractions at regular intervals
o Contraction with increasing intensity and duration
o Expulsion of cervical mucus plug, mixed with blood (show)
o Progressive effacement and dilatation of cervix
Formation of bag of waters

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 85/97
(171). Shoulder dystocia results in the following except :

a. Erbs palsy

b. Klumpkes palsy

c. Sternomastoid swelling

d. Anencephaly

Solution. Ans-171: (d) Anencephaly

Ref.: Duttas -406
Sol :
Shoulder dystocia is a specific case of dystocia whereby after the delivery of the head, the anterior shoulder of the infant cannot pass
below the pubic symphysis, or requires significant manipulation to pass below the public symphysis.
It is diagnosed when the shoulders fail to deliver shortly after the fetal head.
In shoulder dystocia, it is the chin that presses against the walls of the perineum
Although the definition is imprecise, it occurs in approximately 1% of vaginal births.
Despite appropriate obstetric management, fetal injury such as brachial plexus injury, fetal asphyxia, fracture humerus, sternomastoid
haematoma or seven fetal death can be a complication of this obstetric emergency.

Correct Answer. d

(172). Which of the following is used extra-amniotically for MTP?

a. Ethacridine lactate

b. Mannitol

c. hypertonic saline

d. 40% urea

Solution. Ans172: (a) Ethacridine lactate.

Ref: Read the text below
Sol:
Ethacridine lactate is used extra-amniotically.=0.1% emcredyl.Intramniotic agents= 20% hypertonic saline, 40% hypertonic urea,
mannitol.

Correct Answer. a

(173). A pregnant woman in her 32nd wk of gestation is given magnesium sulfate for pre-eclampsia. The earliest clinical indication of
hypermagnesemia is

a. Loss of deep tendon reflexes

b. Flaccid paralysis

c. Respiratory arrest

d. Hypotension

Solution. Ans173: (a) Loss of deep tendon reflexes

Ref: Read the text below
Sol:
States of magnesium excess are characterized by generalized neuromuscular depression. Clinically, severe hypermagnesemia is
rarely seen except in those patients with advanced renal failure treated with magnesium-containing antacids. Hypermagnesemia is
produced intentionally, however, by obstetricians who use parenteral magnesium sulfate (MgSO4) to treat preeclampsia.
MgSO4 is administered until depression of the deep tendon reflexes is observed, a deficit that occurs with modest hypermagnesemia
(over 4 meq/L). Greater elevations of magnesium produce progressive weakness, which culminates in flaccid quadriplegia and in some
cases respiratory arrest from paralysis of the chest bellows mechanism. Hypotension may occur because of the direct arteriolar relaxing
effect of magnesium.
Changes in mental status occur in the late stages of the syndrome and are characterized by somnolence that progresses to coma.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 86/97
(174). High grade squamous intraepithelial lesion (HGSIL) according to revised Bethesda system of reporting of Pap smear includes :

a. Cervical intraepithelial neoplasia (CIN) I and II

b. Human papillomavirus (HPV) change and CIN I

c. CIN II and CIN III

d. HPV, CIN I and CIN II

Solution. Ans-174 : (c) CIN II and CIN III

Ref: BRS Obs and Gyanecology, - 233-234
Sol:
Numerical Dysplasia CIN Bethesda system
1 Benign Benign Normal
A typical squamous cell of undermined
2 Benign with inflammation Benign with inflammation
significance (ASC-US)
Mild dysplasia CIN I Low grade SIL (squamous intraepithelial lesion)

3 Moderate dysplasia CIN II

Severe dysplasia CIN III High grade

4 Carcinoma in situ
5 Invasive carcinoma Invasive carcinoma Invasive carcinoma

Correct Answer. c

(175). Ca-125 increased in the following conditions, except :

a. Endometriosis

b. Dysgerminoma ovary

c. Endometrioid carcinoma ovary

d. Colorectal malignancy

Solution. Ans-175: (d) Colorectal malignancy

Ref: National Medical Series-278
Sol:
Ca-125 assay
Tests of cell surface antigen found on derivatives of the coelomic epithelium, which include endometrium.
Serum levels are elevated in endometriosis (> 35U/ml in 80% cases), abdominal tuberculosis, PID, malignant epithelial ovarian
tumour, chronic liver disease, in 2% normal women; especially during menstruation.
Coelomic epithelial ovarian T have tumor marker
Ca-125-Serous, mucinous, endometrioid and clear cell.

Correct Answer. d

(176). Which of the following does not cause an abortion?

a. Submucous fibroid

b. Asherman syndrome

c. Bicornuate uterus

d. Uterus didelphys

Solution. Ans-176: (d) Uterus didelphys

Ref: Read the text below
Sol:
In uterus didelphys, both horns grow equally and do not cause an abortion.
Poor implantation in Asherman syndrome and submucous fibroid and smaller uterine cavity in a bicornuate uterus can cause an
abortion.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 87/97
(177). A 40-year male presents with primary infertility. His testes are normal in shape but vas were not palpable. Semen analysis revealed
azoospermia. Detailed examination showed low volume, low pH, high viscosity and high liquefaction time. Which of the following is the
most likely cause?

a. CFTR mutation

b. Estrogen receptor mutation

c. Varicocele

d. Hyperprolactinemia

Solution. Ans-177: (a) CFTR mutation

Ref: Novaks Gynecology, 13/e
Sol:
POST-TESTICULAR AZOOSPERMIA
The hypothalamic-pituitary axis and spermatogenesis are normal.
No sperm appear in the ejaculate secondary to congenital absence or obstruction of the vas deferens or ejaculatory ducts, acquired
obstruction of these ducts, or ductal dysfunctions, including retrograde ejaculation.
Although low seminal pH (6.7 to 8.0) or low seminal fructose may signal the congenital absence or obstruction of the vas deferens,
the diagnosis is confirmed by vasography.
In some cases, testicular biopsy may be indicated to differentiate between primary testicular damage and outflow obstruction.
Congenital bilateral absence of the vas deferens (CABVD) is found in 1% to 2% of infertile men and 95% of men with cystic fibrosis

Correct Answer. a

(178). If a patient undergoes ultrasound exam near term, all of the following suggest the possibility of gestational diabetes except:

a. Increased abdominal circumference

b. Increased biparietal diameter

c. Increased amniotic fluid volume

d. Increased placental thickness

Solution. Ans-178: (b) Increased biparietal diameter

Ref: Read the text below
Sol :
Surveillance of patients with GDM frequently utilizes home glucose monitoring with a reflectance meter.
Fetal surveillance usually includes fetal kick counts where the mother is instructed to report fewer than a specified number in a
certain time interval (e.g. < 8 kicks in 2 hours).
Nonstress testing s started at about 32 weeks gestation in patients who require insulin for control. It is usually performed twice
weekly.
Delivery is accomplished by 40 to 42 weeks, depending on the institution and the presence or absence of other obstetrical risk
factors.
Fetal surveillance with ultrasound is also utilized, specified to detect evidence of fetal macrosomia, hydramnios (also known as
polyhydramnios), and increased neonatal skin fold thickness.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 88/97
(179). Congenital anomalies associated with IDDM include all of the following except:

a. Caudal regression syndrome

b. Cleft palate

c. Spina bifida

d. Cardiomegaly

Solution. Ans-179: (b) Cleft palate

Ref: Read the text below
Sol :
Fetal complications of maternal IDDM are similar to those of GDM with the addition of an increased incidence of congenital
anomalies.
The rate of major congenital anomalies in infants of diabetic mothers is about 6-10%. These include anomalies of multiple organ
systems including the skeleton, CNS, the GI tract, the cardiovascular system, and the GU system including renal anomalies.
Cardiac anomalies are the most common, followed by the CNS and skeletal malformations.
It is clear that the incidence of congenital anomalies is related to glycemia control at the time of conception and during early pregnancy.

Correct Answer. b

(180). Patients with metastatic GTN with poor prognostic features should be followed with B-hCG titers for

a. 1 year

b. 2 years

c. 5 years

d. 10 years

Solution. Ans-180: (c) 5 years

Ref: Read the text below
Sol :
The cure rate in patients with good prognosis is about 95%.
In patients with poor prognosis, the cure rate drops to about 50-70%.
This latter group of patients should have monthly titers checked for 2 years and then every 3 months until 5 years after hCG is
undetectable.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 89/97
(181). Which of the following is a risk factor for preterm delivery?

a. Primiparity

b. Fetal anencephaly

c. Chorioamnionitis

d. Placental sulphatase deficiency

Solution. Ans-181: (c) Chorioamnionitis

Ref.: Read the text below
Sol :
Preterm labor :
Preterm labour is defined as the presence of regular uterine contractions that occur before 37 weeks of gestation and are associated
with cervical changes.
Risk factors for preterm labor :
Previous preterm birth
Multiple pregnancy
Chorioamnionitis
Anomalies of uterus or cervix
Maternal diseases such as diabetes (with polyhydramnios), hypertension
Cigarette smoking, alcohol use and illicit drug intake during pregnancy
Increase in concentration of fetal fibronectin in cervicovaginal secretion, is associated with preterm labour.
Management :
Corticosteroids areg given in preterm labour with intact membranes between 28-34 weeks of gestation in order to promote fetal lung
maturity.
Betamethasone is the steroid of choice.
Two contra-indications to steroid use are chorioamnionitis and Eclampsia.

Correct Answer. c

(182). A 16-year-old primigravida presents with severe preeclampsia. She has meconium stained amniotic fluid. Contractions occur every 3
minutes and there is a late deceleration with each contraction. Fetal changes would include which of the following ?

a. Decreased lactic acid

b. Increased pH

c. Increased pCO2

d. Increased pO2

Solution. Ans-182: (c) Increased pCO2

Ref: Read the text below
Sol:
Late deceleration : Usually reflect chronic uteroplacental insufficiency, which is seen in severe preeclampsia. With uteroplacental
insufficiency, fetal hypoxia can develop, resulting in a decrease in fetal partial pressure of oxygen (pO2). At first, a respiratory acidosis
develops in the fetus, which means that partial pressure of carbon dioxide (pCO2) and bicarbonate rises; there is a concomitant decrease
in fetal pH. As the hypoxia continues, a metabolic acidosis develops with a rise in lactic and pyruvic acids.
Deceleration patterns :
1. Early decelaration : Is due to head compression
2. Variable deceleration : Is due to cord compression.
3. Late deceleration : Usually reflect chronic uteroplacental insufficiency.
Sinusoidal pattern : Is associated with
Fetal anemia
Feto-maternal haemorrhage
Fetal hypoxia
When narcotics given to mother

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 90/97
(183). The benefit of female sterilization -

a. Excellent contraception

b. Permanent method of contraception

c. Reduces risk of ovarian cancer

d. All of the above

Solution. Ans-183: (d) All of the above

Ref: Read the text below
Sol:
The female sterilization is an excellent as well as permanent method of contraception. The failure rate is 0.3-0.4/HWY.
It is associated with reduced risk for ovarian cancer that persists for as long as 20 years after surgery.

Correct Answer. d

(184). A patient in the active phase of labor is 5 cm dilated, and the fetal heart monitor shows decreased variability. The monitor shows a
baseline fetal rate of 125 beats per minute (bpm), with occasional late decelerations. A fetal scalp pH of 7.22 is obtained. This situation
indicates which of the following conditions or actions ?

a. Significant fetal metabolic acidosis

b. The need to repeat the fetal scalp pH test in 20 minutes

c. The need for immediate cesarean section

d. Chorioamionitis with maternal fever

Solution. Ans-184: (b) The need to repeat the fetal scalp pH test in 20 minutes
Ref: Read the text below
Sol:
The fetal scalp blood pH :
The normal fetal scalp blood pH ranges between 7.25 to 7.35.
A pH value of less than 7.2 is an indication for urgent interference.
A fetal scalp pH of 7.20 to 7.24 is worrisome but is not indicative of severe distress, asphyxia or metabolic acidosis in the fetus; there
is no need for immediate cesarean section delivery. The scalp pH measurement, however, must be repeated in 20 to 30 minutes.
A chorioamnionitis with a maternal temperature elevation would produce a fetal tachycardia of greater than 160 beats per minute
(bpm).

Correct Answer. b

(185). Which is the most significant finding in cardiotocography for detection of fetal hypoxia:-

a. Late deceleration

b. Variable deceleration

c. Sinusoidal deceleration

d. Early deceleration

Solution. Ans-185: (c) Sinusoidal deceleration

Ref: Read the text below
Sol:
Sinusoidal pattern Associated with
Fetal anemia
Fetomaternal haemorrhage
Fetal hypoxia
When narcotics given to mother
Deceleration patterns :
Late deceleration Is suggestive of chronic placental insufficiency
Variable deceleration Suggestive of cord compression
Early deceleration Suggestive of head compression

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 91/97
(186). Normal stature with minimal or absent pubertal development is seen in

a. Kallman syndrome

b. Turner syndrome

c. Pure gonadal dysgenesis

d. Testicular feminization syndrome

Solution. Ans-186: (a) Kallman syndrome

Ref: Harrisons Principles of Internal Medicine, 18/e; Novaks Gynecology, 13/e
Sol:
Kallman syndrome >Pure gonadal dysgenesis
KALLMAN SYNDROME
The condition results from defective hypothalamic gonadotropin-releasing hormone (GnRH) synthesis and is associated with anosmia
or hyposmia due to olfactory bulb agenesis or hypoplasia.
The syndrome also may be associated with color blindness, optic atrophy, nerve deafness, cleft palate, renal abnormalties,
cryptorchidism and neurologic abnormalties such as mirror movements.
Defect in the KAL gene impair embryonic migration of GnRH neurons from the hypothalamic olfactory placode to the hypothalamus.
Autosomal recessive and dominant modes of transmission have been described.
GnRH deficiency prevents progression through puberty.
Males present with delayed puberty and pronounced hypogonadal features, including micropenis, probably the result of low
testosterone levels during infancy.
Females present with primary amenorrhea and failure of secondary sexual development.

PURE GONADAL DYSGENESIS

The term, pure gonadal dysgenesis refers to 46XX or 46XY phenotypic females who have streak gonads.
This condition may occur sporadically or may be inherited as an autosomal recessive trait or as an X-linked trait in XY gonadal
dysgenesis.
Affected girls are typically of average height and have none of the stigmata of Turner's syndrome, but they have elevated levels of
FSH because the streak gonads produce neither steroid hormones nor inhibin.
When gonadal dysgenesis occurs in 46XY individuals, it is sometimes termed Swyer's syndrome.
[Note: As per Novacs gynecology, any short, slowly growing, sexually infantile girl has Turner's syndrome until proved otherwise]

Correct Answer. a

(187). Manning score comprises all except :-

a. Fetal movements

b. Fetal breathing

c. Amniotic fluid volume

d. Fetal size

Solution. Ans-187: (d) Fetal size

Ref: Read the text below
Sol:
Fetal size has no bearing on manning score.
All other parameters indicate the fetal condition, if it is compromised.

Correct Answer. d

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 92/97
(188). Which of the following procedure confirms the diagnosis of pelvic inflammatory disease-

a. White blood cell count

b. Cervical gram stain

c. Culdocentesis

d. Laparoscopy

Solution. Ans-188(d) Laparoscopy

Ref: Read the text below
Sol:
Laparoscopic abnormalities consistent with PID is a specific criteria for diagnosing PID.
The other specific criteria are histopathological evidence of endometritis or transvaginal sonography or MRI scan showing thickened
fluid filled tubes with or without free pelvic fluid or tubo-ovarian complex.
WBC count increased, ESR elevated, C-reactive protein are some routine criteria for diagnosing PID.

Correct Answer. d

(189). Most common mode of spread of ovarian epithelial tumors is:

a. Lymphatic

b. Hematogenous

c. Direct spread

d. None of these

Solution. Ans-189: (c) Direct spread

Ref.: Read the text below
Sol :
Most common mode of spread of ovarian epithelial tumors is by direct spread.
Epithelial tumors arise from the surface epithelium of the ovary, which is closely related to the coelomic epithelium that lines the
peritoneal cavity.
Ovarian cancer can spread by direct extension: by exfoliation of cells into the peritoneal cavity (transcoelomic spread), via the
bloodstream, or via the lymphatic system.
The most common pathway of spread is transcoelomic; cells from the tumor are shed into the peritoneal cavity and circulated,
following the path of the peritoneal fluid up the paracolic gutters, along the intestinal mesenteries, and up to the diaphragm. Commonly,
the omentum is also involved.

Correct Answer. c

(190). The most common symptom of complete mole is :

a. Hyperemesis

b. Amenorhea followed by vaginal bleeding

c. Abdominal pain

d. Respiratory distress

Solution. Ans-190: (b) Amenorhea followed by vaginal bleeding

Ref.: Read the text below
Sol :
A patient with hydatidirom mole usually presents with amenorrhea for 3-4 month followed by vaginal bleeding.
Bleeding is said to be the universal symptom of molar pregnancy.
Other clinical features are abdominal pain, passage of vesicles, hyperemesis, PIH before 20 weeks and thyrotoxicosis.

Correct Answer. b

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 93/97
(191). The best method of curtailing the second stage of labour in heart disease is by

a. Prophylactic forceps

b. Ventouse

c. Spontaneous delivery with episiotomy

d. Caesarean section

Solution. Ans-191: (b) Ventouse

Ref.: Read the text below
Sol :
Ventouse can be applied with the patient in dorsal position.
The lithotomy position during forceps delivery increases the venous return to the heart and may overload it.

Correct Answer. b

(192). Regarding Manual Vacuum Aspiration (MVA)

a. This procedure is doen under general anaesthetic

b. The equipment should not be reused

c. This method can be used upto a menstrual age of 12 weeks

d. This procedure is more expensive than D & C

Solution. Ans-192: (c) This method can be used upto a menstrual age of 12 weeks
Ref.: Read the text below
Sol :
MVA is an out-patient or an office procedure.
Paracervical block may be needed.
The equipment can be reused many times provided the syringe is kept clean and the cannulae are sterilized
It is cheaper than D & C

Correct Answer. c

(193). The following are related to puerperal foot-drop

a. It is usually bilateral

b. Observed after the first 7 days of delivery

c. it is due to stretching of the lumbosacral trunk of injury to peroneal nerve

d. Surgical intervention is often needed

Solution. Ans-193:(c) It is due to stretching of the lumbosacral trunk of injury to peroneal nerve
Ref.: Read the text below
Sol :
It is observed within a day or two following delivery.
It is usually unilateral
Conservative management is usually done.

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 94/97
(194). Indications of single agent chemotherapy following evacuation of hydatidiform mole are

a. A rise in hCG titre

b. A plaeau of hCG titre for 5-7 days

c. Normalisation of hCG, by 6 weeks post evacuation

d. Appearance of brain metastases

Solution. Ans-194: (a) A rise in hCG titre

Ref.: Read the text below
Sol :
Single agent chemotherapy is indicated when the levels of hCG have remained elevated 8 weeks after evacuation.
Combination chemotherapy is indicated when metastases are present

Correct Answer. a

(195). As per WHO 2010 semen analysis guidelines, what is the normal minimum sperm concentration?

a. 5 million/ml

b. 10 million/ml

c. 15 million/ml

d. 20 million/ml

Solution. Ans-195: (c) 15 million/ml

Ref.: Read the text below
Sol :
Dear friends, some of you might be wondering why the answr is not D. Well, there is a recent change in the normal value of semen
parameters. The table below has the comparison between old and new values.
Parameter Old guidelines WHO 2010 Guidelines
Volume 2 ml 1.5 ml
Sperm concentration 20 million/ml > 15 million/ml
Sperm motility 50% progrestive or > 25% rapidly progressive > 32% progressive
Morphology >30% normal forms > 4% normal forms
WBC <1 million/ml < 1 million /ml
Immunobead or mixed anti globulin reaction
<10% coated with antibodies < 50% coated with antibodies
test

Correct Answer. c

(196). Which among the following is not true about Ashermans syndrome?

a. Cause of secondary amenorrhoea

b. Can result from TB

c. Diagnosed by MRI

d. Treated by hysteroscopy

Solution. Ans-196: (c) Diagnosed by MRI

Ref.: Read the text below
Sol :
Ashermans Syndrome
Formation of intrauterine synechiae due to destruction of the endometrial cavity
It can occur following uterine curettage (maximum chance for post partum curettage), tuberculosis and endometrial ablation
Presents with infertility, secondary amenorrhea or hypomenorrhea the gold standard for diagnosis of intrauterine adhesions is
diagnostic hysteroscopy
Hysteroscopy is both diagnostic as well as curative

Correct Answer. c

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 95/97
(197). Frothy discharge is characteristic of :

a. Trichomoniasis

b. Candidiasis

c. Bacterial vaginosis

d. Genital herpes

Solution. Ans-197: (a) Trichomoniasis

Ref.: Read the text below
Sol :
Trichomoniasis Candidiasis Bacterial vaginosis
Pruistus, burning sensation,
Main symptom Frothy discharge, pruritus Malodourous discharge
discharge
Frothy, greenish yellow,
Discharge Thick, white and curdy Thin, gray and adherent discharge
mucopurulent
Vaginal pH > 4.5 < 4.5 > 4.5
KOH Whiff test Absent Absent Fishy odour
Flagellate trichomonads on saline Hyphae and buds in 10% KOH Clue cells and increased leukocytes in
Microcopy
wet mount solution saline wet mount

Correct Answer. a

(198). Which of the following is a vaccine preventable cancer?

a. Ca Cervix

b. Ca Breast

c. Ca Endometrium

d. Ca Ovary

Solution. Ans-198: (a) Ca Cervix

Ref.: Read the text below
Sol :
HPV vaccines can reduce the incidence of cervical cancer. Two prophylactic vaccines are commercially available:
Gardasil (quadrivalent vaccine) against HPV 6, 11, 16, 18 (approved in women up to 45 yrs of age)
Cervarix (bivalent vaccine) against HPV 16, 18 more efficacy in Ca cervix
Gardasil is administered at 0, 2 and 6 months. Cervarix is administered at 0, 1 and 6 months.
Both vaccines are administered intramuscularly.

Correct Answer. a

(199). Regarding cervical cytology screening all are correct except

a. Screening programmes have failed to reduce the mortality from cervical cancer

b. A dyskaryotic cell often reverts back to normal

c. Papanicolaous grade V smear suggests malignancy

d. A dyskaryotic cell shows pleomorphism and multinucleation

Solution. Ans-199: (a) Screening programmes have failed to reduce the mortality from cervical cancer
Ref.: Read the text below
Sol :
Mortality has steadily declined due to papanicolaou smear screening programmes.

Correct Answer. a

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 96/97
(200). Regarding Sarcoma Botryoides

a. Usually occurs around the age of 10

b. It is an embryonal rhabdomyosarcoma

c. It is not sensitive to chemotherapy

d. It is a tumour of the uterine body

Solution. Ans-200: (b) It is an embryonal rhabdomyosarcoma

Ref.: Read the text below
Sol :
Embryonal rhabdomyosarcoma is a highly malignant tumour, seen commonly below the age of 5, arising from the cervix or vagina
(lower end of mullerian tubercle) and is sensitive to chemotherapy.

Correct Answer. b

Test Answer
1.(b) 2.(d) 3.(b) 4.(c) 5.(a) 6.(c) 7.(a) 8.(a) 9.(d) 10.(c)

11.(b) 12.(d) 13.(a) 14.(b) 15.(d) 16.(a) 17.(c) 18.(a) 19.(b) 20.(c)

21.(d) 22.(c) 23.(b) 24.(b) 25.(a) 26.(a) 27.(a) 28.(c) 29.(c) 30.(b)

31.(d) 32.(b) 33.(c) 34.(a) 35.(b) 36.(d) 37.(c) 38.(d) 39.(b) 40.(b)

41.(a) 42.(b) 43.(d) 44.(b) 45.(d) 46.(d) 47.(a) 48.(d) 49.(d) 50.(c)

51.(c) 52.(d) 53.(d) 54.(a) 55.(b) 56.(d) 57.(c) 58.(d) 59.(a) 60.(a)

61.(a) 62.(b) 63.(d) 64.(c) 65.(a) 66.(a) 67.(c) 68.(c) 69.(c) 70.(d)

71.(b) 72.(a) 73.(a) 74.(a) 75.(d) 76.(a) 77.(b) 78.(a) 79.(b) 80.(b)

81.(c) 82.(a) 83.(d) 84.(d) 85.(c) 86.(d) 87.(b) 88.(a) 89.(b) 90.(d)

91.(d) 92.(c) 93.(d) 94.(d) 95.(c) 96.(b) 97.(d) 98.(b) 99.(b) 100.(c)

101.(d) 102.(a) 103.(b) 104.(c) 105.(d) 106.(d) 107.(a) 108.(a) 109.(c) 110.(c)

111.(b) 112.(b) 113.(d) 114.(c) 115.(b) 116.(a) 117.(d) 118.(b) 119.(d) 120.(c)

121.(d) 122.(c) 123.(c) 124.(d) 125.(c) 126.(c) 127.(d) 128.(a) 129.(b) 130.(d)

131.(b) 132.(c) 133.(b) 134.(d) 135.(a) 136.(d) 137.(c) 138.(c) 139.(d) 140.(b)

141.(b) 142.(d) 143.(c) 144.(a) 145.(a) 146.(d) 147.(b) 148.(a) 149.(b) 150.(d)

151.(c) 152.(d) 153.(a) 154.(c) 155.(b) 156.(a) 157.(d) 158.(a) 159.(c) 160.(c)

161.(d) 162.(d) 163.(c) 164.(b) 165.(b) 166.(b) 167.(a) 168.(b) 169.(c) 170.(b)

171.(d) 172.(a) 173.(a) 174.(c) 175.(d) 176.(d) 177.(a) 178.(b) 179.(b) 180.(c)

181.(c) 182.(c) 183.(d) 184.(b) 185.(c) 186.(a) 187.(d) 188.(d) 189.(c) 190.(b)

191.(b) 192.(c) 193.(c) 194.(a) 195.(c) 196.(c) 197.(a) 198.(a) 199.(a) 200.(b)

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved. 97/97