Obs Mcqs

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1. The thickness of endometrium at the time

of implantation is :
a) 3 – 4 mm
b) 20 – 30 mm
c) 15 –20 mm
d) 30 – 40 mm
Correct Answer - A
Ans. is None/ a i.e. 3-4 mm
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"7he Endometrium is in the secretory phase corresponding to 20 -
21 days of cycle" at the time of implantation.
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"After ovulation, the endometrium now demonstrates a combined

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reaction to estrogen and progesterone activity. Most impressive is

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that total endometrial height is fixed at roughly its preovulatory

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extent (5 -6 mm) despite continued availability of estrogen."

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Reading the above text it is clear that endometrium is - 5 - 6 mm

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thick at the time of implantation, which is not given in the option. Still
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if you have to mark one answer option 'a' i.e. 3 - 4 mm being closest
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could be right.
Extra Edge
Implantation occurs 7 - 9 days after ovulation°.
In human, the blastocyst burrows in the uterine cavity till whole of it
lies within the thickness of endometrium. This is called as interstitial
implantation.
After implantation of the embryo the uterine endometrium is called
the decidua".
Decidua basalis - The part of decidua where the placenta is to be
formed.
Decidua Capsularis - The part of the decidua that separates the
embryo from the uterine lumen. Decidua Parietalis - The part of the
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embryo from the uterine lumen. Decidua Parietalis - The part of the
decidua lining rest of the uterine cavity.
At the end of pregnancy, the decidua is shed off along with placenta
and membranes.
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2. Zygote with zona pellucida reaches uterine

cavity by :
a) 2 days
b) 4 days
c) 5 days
d) 6 days
Correct Answer - B
4 days
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3. Ligamentum terea is formed after ':

a) Obliteration of the umbilical vein
b) Obliteration of the ductus venous
c) Obliteration of the ductus arteriosus
d) Obliteration of the hypogastric artery
Correct Answer - A
Obliteration of the umbilical vein om
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4. The role of human placental lactogen is :

a) Stimulate milk production
b) Fetal breast development
c) Growth of fetus
d) Endocrine regulation
Correct Answer - C
Growth of fetus
Functions :
a) Provide fetal nutrition by antagonizing the action of insulin in
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maternal circulation, breakdown of fats and proteins and transport of

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fatty acids and amino acids from maternal to feta circulation.

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b) Potent angiogenic, helps develop fetal vasculature.

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c) Promotes growth of breast for lactation.

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5. Commonest cause for puerperal sepsis is :

a) Streptococci
b) Anaerobes
c) Gonococci
d) Staphylococci
Correct Answer - A
Streptococci om
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6. The best method for inducing mid trimester

abortion is :
a) Injection of Hypertonic Saline
b) Ethacrydine
c) Prostaglandins
d) D and C
Correct Answer - C
Prostaglandins
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Mid trimester termination of pregnancy
A) Medical methods
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i) Prostaglandins : misoprostol (PGE 1) with or without Mife

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pristone, gemeprost (PGE1), dinoprostone (PGE2), carboprost

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(PGE2)
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ii) Oxytocin
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7. Most common site of Implantation of tubal

pregnancy is :
a) Interstitial portion of fallopian tube
b) Isthmus
c) Ampulla
d) Infundibulum
Correct Answer - C
Ampulla
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Maximum propensity to rupture —> Isthmic ectopic pregnancy.
Minimum propensity to rupture -3 Ampullary ectopic pregnancy.
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8. During which gestational age is peak serum HCG levels attained ?

a) 7-9 weeks
b) 11-13 weeks
c) 20 weeks
d) 25 weeks
Correct Answer - A
HCG rises progressively from conception. Levels double on the average, every 30.9 hours
until values reach 6500 mIU/ml (6,500 IU/L) at approximately the eighth week after the last
menstrual period (LMP).
After that the rate of rise becomes individualized, peaking between the 60th and 70th
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day (9 to 10 weeks) LMP.

HCG decreases slightly between the 12th and 16th week post LMP, and then remains
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constant until birth.

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9. The uterine artery is a branch of which of the following?

a) Left common iliac artery
b) Internal iliac artery
c) Internal pudendal artery
d) Ovarian artery
Correct Answer - B
Uterine arteries arise from internal iliac artery or hypogastric artery.
It runs downwards and forwards along the lateral pelvic wall until the base of the broad
ligament.
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Note: During pregnancy the uterine arteries hypertrophy and their course is straightened.
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Ref: Comp Textbook of Obstetrics and Gynecology, Sadhana Gupta, 2011, Page 18
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10.
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In which part of fallopian tube ectopic pregnancy will have longest survival?
a) Isthmus
b) Ampulla
c) Cornua
d) Interstitium
Correct Answer - D
Ans. D. Interstitium
If the implantation occurs in the antimesenteric border in the
ampulla, the pregnancy may continue a little longer time.
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Earliest interruption occurs in the isthmial implantation and
pregnancy may continue upto 3-4 months in interstitial
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implantation.
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Also know:
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Isthmic rupture usually occurs at 6-8 weeks, the ampullary one at 8-

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12 weeks and the interstitial one at about 4 months.

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Ref: Textbook of Obstetrics by DC Dutta, 6th edition, Page 181.

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11. What would be the type of presentation when the engaging diameter is
mentovertical?
a) Face
b) Brow
c) Vertex
d) Breech
Correct Answer - B
In brow presentation, the engaging diameter is mentovertical (14cm). Brow is the
rarest variety of cephalic presentation where the presenting part is the brow and the attitude
of the of the head is short of that degree of extension necessary to produce face
presentation.
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In face presentation, the presenting part is face, attitude of the fetus shows complete
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flexion of the limbs with extension of the spine. The commonest position is left mento
anterior. The engaging diameter of the head is submento bregmatic 9.5cm in fully
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extended head or submento vertical 11.5cm in partially extended head.

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Ref: Textbook of Obstetrics By D.C Dutta, 6th edn, page 392-3

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12. Which of the following statements regarding fetal circulation is correct?

a) The liver and heart of the fetus receive blood with very high
oxygen saturation
b) PO2 of fetal blood leaving the placenta is slightly greater than

maternal mixed venous PO2
c) The presence of fetal hemoglobin shifts the oxyhemoglobin

dissociation to the right
d) The foramen ovale closes during the third trimester unless the
fetus has an atrial septal defect
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Correct Answer - A
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Since the liver is supplied by umbilical venous blood from the placenta, and the heart
and head receive blood before it has mixed with significant amounts of desaturated
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blood, these important organs receive blood that is relatively high in saturated
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oxyhemoglobin.
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The high rate of blood flow at the placenta and the significant resistance of the placenta to
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diffusion of oxygen result in blood in the umbilical vein that has a lower PO2 (30 mm Hg)
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than the maternal mixed venous blood.

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However, the left shift in fetal oxyhemoglobin concentration and the Bohr effect both act to
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increase the transport of oxygen to fetal tissues.
A number of significant differences in circulating patterns are present in the fetus.
The foramen ovale remains open until after birth and a significant portion of inferior
vena cava flow is shunted through it to the left.
1/3 of blood enters directly from right atrium to left atrium (bypassing right ventricle) through
foramen oval
The major portion of right ventricular output is shunted through the ductus arteriosus to the
aorta, not the lungs.
The net effect of these shunts in the presence of high fetal pulmonary vascular resistance is
very low fetal pulmonary blood flow.
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At birth, these patterns normally are quickly changed to ex-utero patterns with high
pulmonary perfusion.
Ref: Barrett K.E., Barman S.M., Boitano S., Brooks H.L. (2012). Chapter 33. Circulation
through Special Regions. In K.E. Barrett, S.M. Barman, S. Boitano, H.L. Brooks (Eds),
Ganong's Review of Medical Physiology, 24e.
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13. Most common cause of secondary PPH is

:
a) Uterine inertia
b) Retained placenta
c) Episiotomy
d) Cervical tear
Correct Answer - B
Retained placenta
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Secondary PPH
Bleeding usually occurs between 8th to 14th day of delivery.
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Causes of late PPH :

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Retained bits of cotyledon or membranes (M.C.)

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Infection and separation of slough over a deep cervico - vaginal

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laceration.
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Endometritis and subinvolution of the placental site.

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14. The major contribution of the amniotic

fluid after 20 weeks of gestation :
a) Ultrafiltrate and maternal plasma
b) Fetal urine
c) Fetal lung fluid
d) Fetal skin
Correct Answer - B
Ans. B. Fetal urine
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There are two primary sources of amniotic fluid: fetal urine and the
lung liquid.
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After about 20 weeks, fetal urine makes up most of the fluid.

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15.
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Incidence of scar rupture in a subsequent

pregnancy in case of Lower Segment
Cesarean Section (LSCS) is:
a) 2%
b) 4%
c) 5%
d) 8%
Correct Answer - A
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2%
The risk of lower segment scar - rupture is low (0.2-1.5%) and even if
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it does occur, maternal death is much less and the perinatal

mortality is about 1 in 8.
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16. The characteristics of caput succedaneum

include all of the following except :
a) Crosses midline
b) Crosses the suture line
c) It does not disappear within 2-3 days
d) It is a diffuse edematous swelling of the soft tissues of the scalp
Correct Answer - C
It does not disappear within 2-3 days
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Location- subcutaneous plane
Clinical features-
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Soften gradually and disappear within 2-3 days

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Diffuse crosses suture line ill defined margin.

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Not associated with prolonged jaundice

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17. Hydrocephalus is best detected

antenately by :
a) X-ray abdomen
b) Amniocentesis
c) Clinical examination
d) Ultrasonography
Correct Answer - D
Ans. is d i.e. Ultrasonography
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Hydrocephalus is a condition in which there is an abnormal increase
in cerebrospinal fluid within the ventricular and subarachnoid spaces
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of brain.
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"The prenatal diagnosis of hydrocephalus is usually made by

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demonstration of a dilated ventricular system in an ultrasound

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examination."
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Earliest and most accurate sonographic sign of hydrocephalus –

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Enlarged lateral ventricles.°

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The lateral ventricle is measured at the level of atrium.

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Normal transverse diameter of atrium is 7 mm ± 1 mm. (It remains

constant during the second and third trimester)
When diameter of atrium is >10 mm it is called as Ventriculomegaly /
Hydrocephalus.
Other signs of hydrocephalus on USG :
Dangling choroid plexuses.
Thinning out of cerebral cortex.
Extra Edge :
Friends, the terms ventriculomegaly and hydrocephalus are often
used interchangeably but have slightly different meanings.
* Ventriculomegaly : The condition in which lateral ventricles of the
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brain are filled with excessive fluid and enlarge.

* Hydrocephalus : There is ventriculomegaly along with an increase
in the head circumference.
Normal fetal head circumference at term ranges between 32 and 38
cms.
With hydrocephalus, the circumference exceeds 50 cms.
Ventriculomegaly can also be caused by° :
* Spina bifida°
* Chromosomal abnormalities°
* Congenital infections like cytomegalovirus. toxoplasmosis, syphilis
and influenza.°
Dandy walker syndrome includes Hydrocephalus + Posterior fossa
cyst°+ Defect in cerebellar vermis.
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18. Subpubic angle is :

a) <65°
b) 65-75°
c) 85°
d) 110-120°
Correct Answer - C
85° om
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19. Rule of Hasse is used to determine :

a) The age of fetus
b) Height of an adult
c) Race of a person
d) Identification
Correct Answer - A
Ans. is a i.e. The age of fetus
Hasse's rule is employed in calculating the age of fetus by its
length
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During the first five months of pregnancy, the length in cms is square
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of the age in months i.e. Length in cms = (Age in months)?

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Age in months = Qlength in cms

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During second five months of pregnancy, length in cms divided by 5

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is the age in months. Length in ems

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Age in months 5
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20. Banana and lemon sign seen in which

fetal nomalies :
a) Neural tube defect
b) Hydrops fetalis
c) Twins
d) IUD
Correct Answer - A
Ans. is a i.e. Neural tube defect
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Signs of Spina bifida on Ultrasound
Small biparietal diameter.
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Ventriculomegaly.
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Frontal bone scalloping or the so called lemon sign.

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Elongation and downward displacement of the cerebellum-the so

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called banana sign.

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Effacement or obliteration of the cisterna megna.

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21. Indication of Acyclovir in pregnancy :

a) Disseminated herpes
b) Chicken-pox in first trimester
c) Prophylaxis in recurrent herpes
d) All of the above
Correct Answer - D
All of the above om
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22. Lovset manoeuvre is used in delivery of :

a) Head
b) Breech
c) Foot
d) Arms
Correct Answer - D
Arms
Lovset's maneuver
Principle : Because of the curved birth canal, when the anterior
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shoulder remains above the symphysis pubis, the posterior shoulder

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will be below the sacral promontory. If the fetal trunk is rotated

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keeping the back anterior and maintaining a downward traction, the

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posterior shoulder will appear below the symphysis pubis.

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23. Macrosomia is/are associated with:

a) Gestational diabetes mellitus
b) Maternal obesity
c) Hypothyroidism
d) A & B
Correct Answer - D
Ans. is a and b i.e. Gestational diabetes and Maternal obesity
Macrosomia is the term used to describe a large fetus.
The recommended definition is fetal (neonatal) weight exceeding
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two standard deviations or above 90th centile for the appropriate

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normal population.
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According to ACOG : birth weight of > 4500gm is called as

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macrosomia.
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In Indian context Birth weight of > 4000 gm is called as macrosomia.

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24. Drug which is contraindicated before 2nd

stage of labor is:
March 2009
a) Mifepristone
b) Oxytocin
c) Misoprostol
d) Ergometrine
Correct Answer - D
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Ans. D: Ergometrine
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Drugs used for medical method of induction of labour are:

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Mifepristone
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Oxytocin
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Misoprostol (Prostaglandins El)

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Ergometrine is contraindicated in pregnancy, 1st stage of labour, 2nd

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stage of labour before crowning of the head and in breech delivery

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prior to crowning.
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25. Nuchal translucency in USG can be

detected at_____weeks of gestation.
a) 11-13 weeks
b) 18-20 weeks
c) 8-10 weeks
d) 20-22 weeks
Correct Answer - A
Ans. A. 11-13 weeks
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Nuchal translucency is the normal fluid-filled subcutaneous space
identified at the back of the fetal neck during the late first trimester
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and early second trimester (11.3-13.6 weeks).

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26. First line of treatment of mastitis in a

lactating mother is-
a) Dicloxacillin
b) Cefazolin
c) Ceftriaxone
d) Ampicillin
Correct Answer - A
Ans. A. Dicloxacillin
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The beta lactamase-resistant penicillins have been recommended in
the treatment of mastitis. These include cloxacillin, dicloxacillin, or
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flucloxacillin.
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Because penicillins are acidic, they are poorly concentrated in

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human milk, which is also acid.

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Therefore, cloxacillin and its congeners tend to treat cellulitis well,

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but they are less effective in eradicating adenitis, the most likely
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precursor of breast abscess.

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When patients are allergic to penicillins, cephalexin or clindamycin

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may be the alternative to erythromycin.

Combination like co-amoxiclav should be avoided because of fear of
inducing MRSA
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27. Patient with recurrent abortion diagnosed

to have antiphospholipid syndrome. What
will be the treatment?
a) Aspirin only
b) Aspirin + Low molecular weight Heparin
c) Aspirin + Low molecular weight Heparin + Prednisolone
d) No Treatment
Correct Answer - B
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Ans. B. Aspirin + Low molecular weight Heparin

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The recommended treatment for women with recurrent pregnancy

loss associated with antiphospholipid syndrome includes combined
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Aspirin and Heparin therapy.

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In pregnant SLE patients with Antiphospholipid antibodies and prior

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fetal loss, treatment with heparin (standard or low –molecular-

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weight) plus low dose aspirin has been shown in prospective

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controlled trials to increase significantly the proportion of live births.

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Combined aspirin and heparin therapy has proven effectiveness and

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is the preferred treatment for women with recurrent pregnancy loss

associated with antiphospholipid syndrome.
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28. Human placenta is ?

a) Discoid
b) Hemochorial
c) Deciduate
d) All the above
Correct Answer - D
Ans. is 'd' i.e., All the above
The human placenta is :
Discoid, because of its shape.
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Hemochorial, because of direct contact of the chorion with the

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maternal blood andDeciduate, because some maternal tissue is

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shed at parturition.
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29. Twin pregnancy of the same age and sex

rules out ?
a) Superfetation
b) Maternal twins
c) Superfecundation
d) None of the above
Correct Answer - A
Ans. is 'a' i.e., Superfetation
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Superfetation
It is the simultaneous occurrence of more than one stage of
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developing offspring in the same animal.

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In mammals, it manifests as the formation of an embryo from a

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different estrous cycle while another embryo or fetus is already

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present in the uterus.

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30. All are true about uteroplacental

circulation except
a) Blood in the intervillous space is completely replaced 3 - 4
times per minute
b) The villi depend on the maternal blood for their nutrition
c) A mature placenta has 150 ml of blood in the villi system and

350 ml of blood in the intervillous space
d) Intervillous blood flow at term is 500 - 600 ml per minute

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Correct Answer - C
Answer- C. A mature placenta has 150 ml of blood in the villi
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system and 350 ml of blood in the intervillous space

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A mature placenta has a volume of about 500 ml of blood; 350 ml

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being occupied in the villi system and 150 ml lying in the intervillous
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space.
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Intervillous blood flow at term is around 500 - 600 ml per minute.

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The blood in the intervilllous space is completely replaced about 3 -

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4 times per minute.

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The villi depend on maternal circulation for nutrition, thus it is

possible for the chorionic villi to survive for a varying period even
after the fetus is dead.
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31. Uterus is receptive for implantation for

how many days after fertilization -
a) 6 days
b) 12 days
c) 6 weeks
d) 12 weeks
Correct Answer - D
Answer- D. 12 weeks
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Superfetation is the fertilization of two ova released in two different
menstrual cycles. The nidation and development of one fetus over
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another fetus is theoretically possible until the decidual space is

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obliterated by 12 weeks of pregnancy.

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32. Number of stem villi at term in human

placenta is
a) 60
b) 120
c) 240
d) 480
Correct Answer - A
Answer- A. 60
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Functional subunit is called a lobule which is derived from a tertiary
stem villi. About 60 stem villi persist in human placenta. Thus each
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cotyledon (total 15 - 29) contains 3 - 4 major stem villi. The villi are
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the functional unit of the placenta. The total villi surface, for
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exchange, approximately varies between 10 to 14 square metres.

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The fetal capillary system within the villi is almost 50 km long.

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33. All are of value in modified Bishop score

except
a) Dilatation
b) Effacement
c) Cervical length
d) Consistency
Correct Answer - B
Answer- B. Effacement
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34. G2P1L1 female with 1 : 4 anti D titres at 28

weeks gestation, management is
a) MCA Doppler
b) Caesarean section
c) Induction of labour
d) Amniocentesis
Correct Answer - A
Answer- A. MCA Doppler
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If Indirect Coomb's test is positive in an antenatal patient with Rh
negative blood group, and antibody titres >1 : 16 or Ab level > 10
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IU/ml
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1. Serial MCA Doppler, every 1 - 2 weeks from 20 weeks

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2. Serial ultrasonography every 2 - 3 weeks from 20 weeks

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35. Patient with NTD, dose of folic acid in next

pregnancy
a) 0.5 mg
b) 1 mg
c) 2 mg
d) 4 mg
Correct Answer - D
Answer- D. 4 mg
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Folic acid supplementation 4 mg daily 1 month before conception to
about 12 weeks of pregnancy.
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36. Kallmans syndrome is associated with all

of the following except
a) Amenorrhea
b) Excess stimulation of the HPO axis
c) Genetic mutation
d) Anosmia
Correct Answer - B
Answer- B. Excess stimulation of the HPO axis
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When congenital GnRH deficiency is associated with anosmia or
hyposmia (an absent or grossly impaired sense of smell), the
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disorder is known as Kallmann's syndrome.

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Two genetic mutations associated with Kallman's Syndrome :

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1. KAL gene - X - linked inheritance (Xp22.3) encoding anosmin - 1.

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2. Gene encoding FGFR1 (Fibroblast growth factor - 1 receptor) -

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autosomal dominant form.

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Anosmin - 1 is a neural adhesion molecule that promotes migration

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of GnRH neurons and olfactory neurons, from the olfactory placode

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into the hypothalamus during embryonic development.
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37. Hot flushes are experienced as a result

of
a) Increased noradrenaline
b) Decreased estrogen
c) Increased noradrenaline and decreased estrogen
d) Increased noradrenaline and estrogen
Correct Answer - C
Answer- C. Increased noradrenaline and decreased estrogen
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Hot flushes are caused by noradrenaline, which disturbs the
thermoregulatory system. Oestrogen deficiency reduces
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hypothalamic endorphins, which release more norepinephrine and

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serotonin. This leads to inappropriate heat loss mechanism.

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Other causes that can be associated with the symptom of hot

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flushes include: thyroid disease, epilepsy, pheochromocytoma,

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carcinoid syndromes, autoimmune disorders, mast cell disorders,

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insulinoma, pancreatic tumours and even leukemias.

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38. Cephalic index is

a) BPD/OFD
b) BPD/HC
c) OFD/BPD
d) HC/FL
Correct Answer - A
Answer- A. BPD/OFD
Cephalic index = BPD / OFD (Biparietal diameter divided by the
occipito - frontal diameter)
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39. If the symphysiofundal height is 40 cm

and the station of the head is at -1, weight
of the fetus is approximately
a) 3 kg
b) 3.3 kg
c) 4 kg
d) 4.3 kg
Correct Answer - D
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Answer- D. 4.3 kg
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Johnson's Formula for estimation of fetal weight :

Height of the uterus above the symphysis pubis in centimeters
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minus 12, if the vertex is at or above the level of ischial spines or

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minus 11, if the vertex is below the level of ischial spines - multiplied
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by 155 gives the weight in grams.

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Solution : (40 - 12) x 155 = 4340 gms

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40. In MRKH syndrome, which among the

following is absent?
a) Vagina
b) Breast development
c) Pubic hair development
d) Testes
Correct Answer - D
Answer- D. Testes
om
MRKH syndrome is also known as MURCS syndrome (Mullerian
agenesis, Renal aplasia and cervicothoracic somite dysplasia).
r.c
MRKH (Mayer Rokitansky Kuster Hauser) syndrome has a

ke
karyotype of 46, XX. So the gonads present are ovaries in contrast

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to Androgen Insensitivity Syndrome where testes are present.

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The MRKH syndrome is characterized by congenital aplasia of the

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uterus and the upper part (2/3) of the vagina in women showing
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normal development of secondary sexual characteristics and a

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normal 46, XX karyotype.

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41. What is the preferred treatment of

complete prolapse in a female with
completed family?
a) Sling surgery
b) Vaginal hysterectomy
c) Le Forte's repair
d) Pessary
Correct Answer - B
om
Answer- B. Vaginal hysterectomy

r.c
Vaginal hysterectomy is commonly performed for major degree

uterine prolapse in a female with completed family.
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42. Which of the following is not a probable

sign of pregnancy
a) Jacquemier's sign
b) Dalrymple sign
c) Hegar's sign
d) Palmer's sign
Correct Answer - B
Answer- B. Dalrymple sign
om
Probable signs of pregnancy :
Jacquemier's sign/Chadwick's sign
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Osiander's sign
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Goodell's sign
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Piskacek's sign
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Hegar's sign
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Palmer's sign
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Braxtor-hicks contraction
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External ballotment
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Abdominal enlargement
Outlining the fetus
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43. Polyspermy is inhibited by which ion ?

a) Ca
b) Na
c) K
d) Cl
Correct Answer - A
Ans, A. Ca
The calcium wave amplifies the local signal at the site of sperm-
oocyte interaction and distributes it throughout the oocyte cytoplasm.
om
The increase in calcium concentration is the signal that causes the

r.c
oocyte to resume cell division, initiating the completion of meiosis II

ke
and setting of the developmental programme that leads to

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embryogenesis.
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44. Which of the following is present in

normal vagina?
a) Trichomonas buccalis
b) Trichomonas hominis
c) Trichomonas vaginalis
d) Trichomonas bovis
Correct Answer - C
Ans. C. Trichomonas vaginalis
om
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45. Maximum amniotic fluid at ?

a) 32 weeks
b) 34 weeks
c) 36 weeks
d) 40 weeks
Correct Answer - C
Ans, C. 36 weeks om
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46. At 20 weeks of gestation amniotic fluid

volume is ?
a) 200 ml
b) 400 ml
c) 600 ml
d) 800 ml
Correct Answer - B
Ans, B. 400 ml
om
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47. Fertilized ovum reaches the uterus at what

day of menstrual cycle?
a) 6th
b) 14th
c) 20th
d) 25th
Correct Answer - C
Ans, C. 20th
om
Implantation of the fertilized ovum occurs in the endometrium of the
anterior or posterior wall of the body near the fundus on the & ilay of
r.c
fertilization which corresponds to the 20th day of the regular

ke
menstrual cycle.
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48.
om
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Fertilization usually occurs in which part of

fallopian tube?
a) Fimbrial end
b) Ampulla
c) Interstitium
d) Isthmus
Correct Answer - B
Ans. B. Ampulla
om
Fertilization is the process of fusion of the spermatozoon with the
mature ovum.
r.c
It begins with sperm egg collision and ends with production of a

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mononucleated single cell called the zygote.

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Its objectives are:

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1. To initiate the embryonic development of the egg and

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2. To restore the chromosome number of the species.

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Almost always, fertilization occurs in the ampullary part of the uterine

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tube.
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49. Physiologic change in leukocyte numbers

in pregnancy is
a) Neutrophilic leukocytosis
b) Lymphocytic leukocytosis
c) Neutropenia
d) Basophilic leukocytosis
Correct Answer - A
Ans. A. Neutrophilic leukocytosis
om
Physiological change observed in leukocyte numbers in pregnancy
is neutrophilic leukocytosis.
r.c
It occurs to the tune of 8000/mm3 and may upto 20,000/ mm3 in

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labour.
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The increase maybe due to the rise in levels of estrogen and

tR
cortisol.
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50. Weight of uterus at term is ?

a) 400-500 gm
b) 600-700gm
c) 800-900 gm
d) 900-1000 gm
Correct Answer - D
Ans. D. 900-1000 gm
The uterus in the non-pregnant state weight is about 60 gm, with a
cavity of 5 - 70 ml and measures about 7.5 cm in length.
om
At term it weighs about 900 - 1000 gm and measures 35 cm in

r.c
length.
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51. During pregnancy estrogen causes which

of the following?
a) Growth of ducts of breasts
b) Growth of alveoli of breasts
c) Both a and b
Correct Answer - C
Ans. C. Both a and b
om
The increased size of the breasts is evident in the early weeks of
pregnancy.
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The increase in size is due to hypertrophy and proliferation of the

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ducts and the alveoli.

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Estrogen is responsible for the hypertrophy and proliferation of the

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ducts and alveoli while progesterone is only responsible for the

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hypertrophy and proliferation of the alveoli.

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52. Maternal side layer of the placenta is

called ?
a) Decidua basalis layer
b) Decidua capsularis layer
c) Decidua parietalis
d) Decidua spongiosa
Correct Answer - A
Ans., A. Decidua basalis layer
om
Decidua basalis (Decidual plate) is the part of endometrium related
to embryonic pole of conceptus and forms the maternal p art of
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placenta.
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53. Which of the following is not a

physiological change of pregnancy in
urinary bladder?
a) Edematous mucosa
b) Increased frequency at 14 weeks
c) Stress incontinence
d) Pressure on bladder in late pregnancy
Correct Answer - B
om
Ans.B. Increased frequency at 14 weeks

r.c
Physiological changes in bladder in pregnancy

Marked congestion and hypertrophy of the muscles and elastic
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tissues of the bladder wall.

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Edematous bhdder mucosa in late pregnancy especially in

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primigravida.
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Increased frequency of micturition at 6 - 8 weeks which subsides by

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12 weeks and reappears in late pregnancy due to pressure of the

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gravid uterus on bladder.

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Stress urinary incontinence in late pregnancy.
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54. Urinary retention earliest in pregnancy is

seen at ?
a) 10 weeks
b) 18 weeks
c) 22 weeks
d) 34 weeks
Correct Answer - A
Ans, A. 10 weeks
om
Urinary retention in pregnancy is rare
It is classically described in some women with retroverted uterus,
r.c
which becomes impacted in the pelvis, usually seen earliest

ke
between 8 - 12 weeks of pregnancy and causes outflow obstruction.

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55. Beta HCG is detected earliest by which

day of conception?
a) 8 days
b) 15 days
c) 21 days
d) 30 days
Correct Answer - A
Ans, A. 8 days
om
hCG is a glycoprotein produced by the syncytiotrophoblast.
hCG-c is identical to the c subunit of LH, FSH, and TSH.
r.c
Its presence in the urine in early pregnancy is the basis of the

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various laboratory tests for pregnancy, and it can sometimes be

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detected in the urine as early as 14 d after conception and in serum

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as early as 8-9 days,

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56. Doubling time of beta HCG in early

pregnancy is ?
a) 24 hrs
b) 48 hrs
c) 72 hrs
d) 96 hrs
Correct Answer - B
Ans, B. 48 hrs
om
Beta hCG usually double about every 2 days (48 hours) during first
four weak of pregnancy.
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As pregnancy progresses, doubling time becomes longer. By 6-7

ke
weeks beta hCG levels may take as long as 3.5 days to double.
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57. Tubal patency test in which phase of the

menstrual cycle?
a) Menstrual
b) Preovulatory
c) Leuteal
d) Premenstrual
Correct Answer - B
Ans, B. Preovulatory
om
The testing of tubal patency and detecting tubal pathology are done
in pre-ovulatory phase of the menstrual cycle.
r.c
If performed in the post-ovulatory period, insufflation might disturb

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an implanted or fertilized ovum and may also cause pelvic

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endometriosis.
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58. Following physiological changes are seen

in vagina in pregnancy except ?
a) Jacquimiers sign
b) Increased length of anterior vaginal wall
c) pH acidic
d) Decreased number of navicular cells
Correct Answer - D
Ans, D. Decreased number of navicular cells
om
The vaginal walls become hypertrophied, edematous and more
vascular.
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Increased blood supply to venous plexus surrounding the walls gives

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bluish coloration of the mucosa (Jacquemier's sign).

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The length of the anterior vaginal wall is increased.

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The secretion of vagina becomes copious, thin and curdy white, due
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to marked exfoliated cells and bacteria.

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The pH becomes acidic (3.5 - 6) due to more conversion of glycogen

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into lactic acid by lactobacillus acidophilus consequent on high

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estrogen level.
The acidic pH prevents multiplication of pathogenic organisms.
There is predominance of navicular cells in cluster and plenty of
lactobacilli.
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59. FHS can be usually heard by stethoscope

at ?
a) 14 weeks
b) 18 weeks
c) 22 weeks
d) 26 weeks
Correct Answer - B
Ans, B. 18 weeks
om
Fetal heart sound (FHS) is most conclusive clinical sign of
pregnancy. With an ordinary stethoscope it can be detected between
r.c
18 - 20 weeks of PregnancY.
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60. What is the fetoplacental relationship at

24 weeks of gestation?
a) 3
b) 4
c) 5
d) 6
Correct Answer - A
Ans, A. 3
om
The relationship between the fetal and placental weights can be
studied by the so called fetoplacental relationship (fetal weight/
r.c
placental weight ratio).

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The fetoplacental relationship increases as the pregnancy advances.

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61. Down syndrome is earliest diagnosed at ?

a) 8 - 10 weeks
b) 10 - 12 weeks
c) 12 - 14 weeks
d) 14 - 16 weeks
Correct Answer - B
Ans. B. 10 - 12 weeks
Earliest diagnosis of genetic defects can be done by use of chorionic
villous sampling.
om
Chorionic villous sampling is carried out transcervically at 10 - 12

r.c
weeks and transabdominally from 10 weeks to term.

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62. Chorionic villus biopsy is done earliest in

which week of gestation ?
a) 9 weeks
b) 11 weeks
c) 13 weeks
d) 15 weeks
Correct Answer - B
Ans, B. 11 weeks
om
It is carried out transcervically between 7O - 12 weeks and
transabdominally from 10 weeks to term.
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63. When is folic acid started in pregnancy ?

a) 4 weeks prior to conception
b) 8 weeks prior toconception
c) 4 weeks after conception
d) 8 weeks after conception
Correct Answer - A
Ans. A. 4 weeks prior to conception
Folic acid supplementation (4mg/day) is stated 4 weeks prior to
conception and continued upto 12 weeks of pregnancy.
om
This can reduce the incidence of neural tube defects.

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64. Term placenta weight to Baby weight ratio

is ?
a) 1 : 3
b) 1 : 4
c) 1 : 5
d) 1 : 6
Correct Answer - D
Ans, D. 1 : 6
om
The term Placenta
Placenta at term is a circular disc with a diameter of 15 - 20 cm.
r.c
It has thickness of 3 cm at center and thins of towards the edges.

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It feels spongy and weighs about 500 gm.

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The ratio of placemat weight at term and the baby weight is 1:6.
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It occupies about 30% of the uterine wall.

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65. First trimester diagnosis for anencephaly

is by increased?
a) Alpha feto protein in maternal serum
b) Alpha feto protein in amniotic fluid
c) Beta HCG in maternal serum
d) Beta HCG in amniotic fluid
Correct Answer - B
Ans, B. Alpha feto protein in amniotic fluid
om
In the first half of the pregnancy the diagnosis of anencephaly is
made by elevated alpha feto protein in amniotic fluid and confirmed
r.c
by sonography.
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66. Which of the following is true about EDD ?

a) Less than 10% of deliveries occur on EDD
b) Less than 20% of deliveries occur on EDD
c) 80% of the deliveries occur on EDD
d) 90% of the deliveries occur on EDD
Correct Answer - A
Ans, A. Less than 10% of deliveries occur on EDD
Fewer than 5% of all the pregnancies end on the expected date of
delitery (EDD).
om
13% of the births occur preterm.

r.c
5 - 7% of the pregnancies are delivered post term.

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Majority of the deliveries occur within 7 days of EDD.

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67. a) Most common position of engagement

in vertex presentation?
a) LOA
b) ROA
c) LOP
d) ROP
Correct Answer - A
Ans, A. LOA
om
Vertex occupying the left anterior quadrant of the pelvis is the
commonest and is called left occipito -anterior position.
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68. Which is the engaging diameter in

occipitoposterior nresentation?
a) Suboccipito frontal
b) Mento vertical
c) Submentovertical
d) Bitrochanteric
Correct Answer - A
Ans, A. Suboccipito frontal
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69. Which is the most common presentation

in twin pregnancy?
a) Vertex - vertex
b) Vertex - breech
c) Breech - Breech
d) Vertex - Footling
Correct Answer - A
Ans. A. Vertex - vertex
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70. Direct Occipitoposterior position is a

favourable position in which type of pelvis
?
a) Anthropoid
b) Android pelvis
c) Gynaecoid
d) Mongoloid
Correct Answer - A
om
Ans, A. Anthropoid
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Direct Occipitoposterior position is a favourable position in

anthropoid type of pelvis.
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71. Persistent OP position is most common in

which pelvis?
a) Android
b) Gynaecoid
c) Anthrpoid
d) Mixed
Correct Answer - A
Ans, A. Android
om
With android type of pelvis the occipitoPosterior position is common
due to funnel shape of the pelvis.
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72. Contraindication for induction of labour is

all except?
a) Hypertensive disease of pregnancy
b) Heart disease of pregnancy
c) Pelvic tumor
d) Vasa previa
Correct Answer - A
Ans. A. Hypertensive disease of pregnancy
om
Hypertensive disease of pregnancy is an indication for induction of
labour. Other three are contraindications.
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73. Medical management of ectopic

pregnancy has decreased success if ?
a) Gestational sac < 3cm
b) Duration of gestation < 5 weeks
c) Cardiac activity present
d) Beta HCG < 8000 IU/L
Correct Answer - C
Ans. C. Cardiac activity present
om
Medical management of an ectoPic Pregnancy is done when :
Patient is hemodynamically stable
r.c
No evidence of acute intra abdominal bleeding

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Ready to comply with follow up care

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Serum beta HCG < 10,000 IU/L

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Absent embryonic heart activity

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Diameter of ectopic gestational mass less than 4 cm.

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74. All are the prognostic factors of Boer-

meisel system except -
a) Extent of adhesions
b) Thickness of tubal wall
c) Size of hydrosalpinx
d) Infecting organism
Correct Answer - D
Ans, D. Infecting organism
om
Boer-meisel system of prognostic classification for chronic
pelvic inflammatory disease includes:
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Extent of adhesions
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Nature of adhesions flimsy or dense

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Size of hydrosalpinx
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Macroscopic condition of hydrosalpinx

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Thickness of tubal wall

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75. Pregnant uterus will compress ureters at

?
a) Pelvic brim
b) Uterovesical junction
c) Trigone
d) Ureterovesical junction
Correct Answer - A
Ans, A. Pelvic brim
om
Ureters become atonic due to high progesterone level in pregnancy,
Dilatation of the ureter above the pelvic brim with stasis is marked
r.c
on the right side especially in the primigravidae.

ke
It is due to deoxtrorotation of the uterus pressing the right ureter

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against the pelvic brim and abo due to pressure by right ovarian
tR
vein, which crosses the right ureter at right angle.

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76. Following is given to a patient with pre

term labour exept -
a) Glucocorticoids
b) Tocolytic drugs
c) Antibiotics
d) Beta blocker
Correct Answer - D
Ans. D. Beta blocker
om
Tocolytic drugs [Note: betamimetic and not beta blocker is a
tocolytic]
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77. Most common cause of tenth day post

partum bleeding?
a) Retained bits of membrane
b) Infection
c) Endometritis
d) Blood coagulopathy
Correct Answer - A
Ans. A. Retained bits of membrane
om
Postpartum hemorrhage (PPH) is defined as blood loss of more than
500 ml following birth of baby.
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78. A multgravida 4 kg fetus is in labour since

15 hours and has 5cm dilation of cervix
for last 8 hours. What is the further
management of this patient ?
a) Wait and watch
b) Amniotomy
c) Injection Oxytocin
d) Caesarian section
om
Correct Answer - D
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Ans. D. Caesarian section

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79. The treatment of choice for bartholin cyst

is ?
a) Marsupilisation
b) Aspiration
c) Observe
d) Curettage and closure
Correct Answer - A
Ans. A. Marsupilisation
om
Bartholin's cyst
Bartholin's cyst is formed when duct of bartholins gland is blocked
r.c
either by inflammation or by inspissated secretion.

ke
It appears as a swelling on the inner side of the junction of the

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anterior two-thirds with the posterior one-third of the labium majus.

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A small cyst remains asymptomatic, but a larger one bulges across

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the vaginal introitus and causes dyspareunia, discomfort and may

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get infected when it needs excision or marsupialization

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80. Gartner's cyst are seen at ?

a) Antero lateral vaginal wall
b) Antero - lateral cervix
c) Posterolateral vaginal wall
d) Posterolateral cervix
Correct Answer - A
Ans, A,’. Antero lateral vaginal wall
Gartners duct cyst arises from the remnants of the mesotephric duct
and lies in the anterolateral aspect of vaginal wall.
om
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81. Most common cause of death of baby in

vasa previa is?
a) Infection
b) Maternal exanguination
c) Fetal exanguination
d) Both b and c
Correct Answer - C
Ans, C. Fetal exanguination
om
Vasa previa
In it a leash of blood vessels happen to traverse through the
r.c
membranes overlying the internal os, in front of presenting part.

ke
Rupture of membranes involving the overlying vessels leads to

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vaginal bleeding.
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As it is entirely fetal blood, this may result in fetal exanguination and

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even death.
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82. Sheehan syndrome is ?

a) Pitutary adenoma
b) Pitutary necrosis
c) Adrenal necrosis
d) Adrenal adenoma
Correct Answer - B
Ans., B. Pitutary necrosis
Sheehan's syndrome is anterior pituitory necrosis following severe
PPH, shock or severe infection.
om
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83. Most common cause of menorrhagia in

adolescents?
a) Thyroid disorder
b) Coagulation disorders
c) Leiomyomas
d) Polyps
Correct Answer - B
Ans, B. Coagulation disorders
om
In adolescent age group, abnormal uterine bleeding results from
anovulation and coagulation defects at disproportionately higher
r.c
rates compared with older reproductive-aged women

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Coagulation disorders account for 20% of cases of menorrhagia in

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adolescents.
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84. Not associated with endometrial

hyperplasia ?
a) PCOD
b) Glucose intolerance
c) HRT
d) Unopposed exposure to progesterone
Correct Answer - D
Ans. D. Unopposed exposure to progesterone
om
Following are the causes of endometrial hyperplasia
Follicular cysts of ovary
r.c
PCOD
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Granulosa and theca cell tumors of ovary

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HRT
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Glucose in tolerance
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Unopposed exposure to estrogen (endogenous or exogenous)

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85. Following are the causes of maternal

deaths in patients with hypertensive
disorder of pregnanacy except ?
a) Cardiac failure
b) ARDS
c) Chronic renal failure
d) Cerebral hemorrhage
Correct Answer - C
om
Ans. C. Chronic renal failure

r.c
Causes of maternal deaths in cases of hypertensive disorders

of pregnancy are
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Cardiac failure
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Cerebral hemorrhage
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ARDS
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Puerperal sepsis
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Pulmonary edema
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Acute renal failure

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Pulmonary embolism
Aspiration and/or septic pneumonia
Cardio-pulmonary arrest
Post-partum shock
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86. Classical name of mid cycle abdominal

pain with vaginal bleeding is called ?
a) Endometriosis
b) Mittelschmez
c) Meteropathiahemorrhagica
d) Menometrorrhagia
Correct Answer - B
Ans. B. Mittelschmez
om
Mittelschmerz is a mid-cycle pain, not lasting more than 12-24
hours, around ovulation. Pain is located in one of the iliac fossa and
r.c
may be accompanied with vaginal bleeding.

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87. Following is true about leuteoma of

pregnancy ?
a) Usually bilateral
b) It is a benign self limiting condition
c) It consists of leutenized cells
d) All the above
Correct Answer - D
Ans. D. All the above
om
Leuteoma of Pregnancy
It usually appears as bilateral, multinodular, solid masses in ovaries.
r.c
It is characterized by replacement of normal ovarian parenchyma by

ke
solid proliferation of leutenized stromal cells under influence of

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human chorionic gonadotroPin.

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It is benign self-limiting condition and requires no treatment.

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88. Clinical alarming sign of MgSO4 toxicity is

?
a) Loss of knee jerk
b) Loss of superficial abdominal reflexes
c) Loss of pin prick sensation
d) Loss of proprioception
Correct Answer - A
Ans. A. Loss of knee jerk
om
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89. False about MgSo4 is ?

a) Not used as antihypertensive
b) Its dose is different for eclampsia and preeclampsia
c) Deep tendon reflexes is monitored for toxicity
d) It acts as a membrane stabilizer and neuroprotector
Correct Answer - B
Ans. B. Its dose is different for eclampsia and preeclampsia
Dose of magnesium sulphate for management of pre-eclampsia and
eclampsia is the same.
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90. 18 weeks pregnancy of a lady, last two

times history of midtrimester abortion,
which was painless. What is the diagnosis
?
a) Incompetent os
b) Chromosomal abnormality
c) Bivalve uterus
d) Progesterone deficiency
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Correct Answer - A
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Ans. A. Incompetent os
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Most common cause of second trimester pregnancy loss is cervical

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incompetence, in which patient presents with recurrent painless

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abortion.
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91. Following are the features of true labour

pain ?
a) Uterine contractions at regular intervals
b) Progressive effacement and dilation of cervix
c) Formation of bag of membranes
d) All the above
Correct Answer - D
Ans. D. All the above
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Features of true labour Pains
Uterine contractions at regular intervals
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Frequency of contractions increase gradually

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Intensity and duration of contractions increase progressively

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Associated with show

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Progressive effacement and dilation of cervix

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Descent of the presenting part

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Formation of bag of forewaters

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Not relieved by enema and sedatives

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92. HRT improves ?

a) Bone density
b) Demetia
c) Coronary artery disease
d) Endometrial cancer
Correct Answer - A
Ans, A. Bone density
Hormone replacement therapy improves bone density,
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93. Most common risk factor for rupture of

scarred uterus is
a) Use of oxytocin in labour
b) Grand multiparity
c) Forceps application
d) Obstructed labour
Correct Answer - A
Ans, A. Use of oxytocin in labour
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The most common cause of rupture of scarred uterus k use of high
doses of oxytocin for the augmuntation of labour.
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94. Invalueable tool in the diagnosis of

chronic pelvic pain is ?
a) Endometrial biopsy
b) Ultrasound
c) Laparoscopy
d) Colposcopy
Correct Answer - C
Ans, C. Laparoscopy
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Laproscopy is an invalueable diagnostic tool in the investigation of
chronic pelvic pain.
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95. Most common site of ectopic pregnancy is

?
a) Ovary
b) Fallopian tube
c) Peritoneum
d) Cervix
Correct Answer - B
Ans. B. Fallopian tube
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96. Least common site of ectopic pregnancy

in fallopian tubes is ?
a) Interstitium
b) Ampulla
c) Infundibulum
d) Isthumus
Correct Answer - A
Ans, A. Interstitium
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Most common site for ectopic pregnancy fallopian tubes,
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97. Criteria for Puerperal pyrexia is

temperature ?
a) 100.4 degrees F on two separate occasions
b) 101 degrees F on two separate occasions
c) 100.4 degrees F on three separate occasions
d) 101 degrees F on three separate occasions
Correct Answer - A
Ans, A. 100.4 degrees F on two separate occasions
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Puerperal pyrexia
A rise of temperature reaching 100.4 degrees F (38 degrees C) or
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more (measured orally) on two separate occasions at 24 hours apart

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(excluding first 24 hours) within first 10 days following delivery is

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called puerperal pyrexia.

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98. Investigation of choice for diagnosis of

PID is ?
a) Laparoscopy
b) Colposcopy
c) Hysteroscopy
d) Ultrasonography
Correct Answer - A
Ans, A. Laparoscopy
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Laparoscopy is considered the investigation of choice for the
diagnosis of pelvic inflammatory disease.
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99. Which drug is preferred for the treatement

of 21 hydroxylase deficient female fetus to
prevent genital virilization?
a) Materal cortisol
b) Maternal dexamethasone
c) Maternal hydrocortisone
d) Maternal methylprednisolone
Correct Answer - B
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Ans, b. Maternal dexamethasone

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Fetus is at risk of CAH maternal dexamethasone therapy can

suppress the fetal HPA axis and prevent
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genital virilization in affected female fetus.

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100. Speilberg criteria is used for ?

a) Ovarian pregnancy
b) Ovarian malignancy
c) Cervical pregnancy
d) Cervical malignancy
Correct Answer - A
Ans, A. Ovarian pregnancy om
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101. Main factor responsible for increased

perinatal mortality in twin pregnancy is ?
a) Prematurity
b) IUGR
c) Polyhydramnios
d) Uterine rupture
Correct Answer - A
Ans, A. Prematurity
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102. Cryptomenorrhoea is a feature of ?

a) Vaginal atresia
b) Turner syndrome
c) Empty sella syndrome
d) Gonadal agenesis
Correct Answer - A
Ans, A. Vaginal atresia om
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103. . Which of the following antiepileptic

drug is associated with causing
congenital heart disease in fetus?
a) Barbiturates
b) Valproate
c) Carbamazepine
d) Phenytoin
Correct Answer - A
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Ans. A. Barbiturates
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104. Engagement of head in labour means ?

a) Smallest horizontal plane of the presenting part has crossed the
pelvic brim
b) Greatest horizontal plane of the presenting part has crossed the

pelvic brim
c) Smallest horizontal plane of the presenting part has crossed the

pelvic outlet
d) Greatest horizontal plane of the presenting part has crossed the

pelvic outlet
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Correct Answer - B
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Ans. B. Greatest horizontal plane of the presenting part has

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crossed the pelvic brim

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When the greatest horizontal plane of the presenting part has

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passed the plane of pelvic brim the presenting part is said to be

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engaged.
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105. USG of 28 weeks gestation showing

oligohydramnios is likely to be due to ?
a) Gastroinstestinal obstruction
b) Renal pathway obstruction
c) Anencephyaly
d) Neuromuscular disorder
Correct Answer - B
Ans, B. Renal pathway obstruction
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Urinarytract obstruction is an important cause of oligohydramnios.
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106. Anovulatory DUB is due to ?

a) Absence of progesterone
b) Excess of estrogen
c) Hypothalmic pitutary defect
d) High progesterone
Correct Answer - A
Ans. A. Absence of progesterone
No progesterone is produced when ovulation does not occur, and
thus proliferative endometrium persists.
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At the tissue level, persistent proliferative endometrium is often

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associated with stromal breakdown, decreased spiral arteriole

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density, and increased dilated and unstable venous capillaries.

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At the cellular level, the availability of arachidonic acid is reduced,

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and prostaglandin production is impaired.

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For these reasons, bleeding associated with anovulation is thought

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to result from changes in endometrial vascular structure and in

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prostaglandin concentration, and from an increased endometrial

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responsiveness to vasodilating prostaglandins.

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107. In carcinoma cervix surgery to retain

conception is done in which stage ?
a) 1B1
b) 1B2
c) 2A
d) 2B
Correct Answer - A
Ans. A. 1B1
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Concepts is retained upto term only in stage I A1.
In other stages, hysterectomy is done with fetus left in situ (if it is not
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viable); or delivery of fetus by classic cesarean hysterectomy

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followed by radiation (if fetus is viable).

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108. Bishop scoring is done for ?

a) Exchange transfusion in newborn
b) Induction of labour
c) Ventilation of Newborn
d) Gestation of Newborn
Correct Answer - B
Ans. B. Induction of labour
Bishop score, also Bishop's score, also known as cervix score is a
pre-labor scoring system to assist in predicting whether induction of
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labor will be required.

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109. Teratozoospermia refers to?

a) Absence of semen
b) Absence of sperm
c) All dead sperms in ejaculate
d) Morphologically defective sperms
Correct Answer - D
Ans. D. Morphologically defective sperms
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110. Bispinous diameter in anatomic outlet ?

a) 10.5 cm
b) 11 cm
c) 11.5 cm
d) 12 cm
Correct Answer - B
Ans. B. 11 cm
Anatomical outlet
Antero-posterior (13 cm)
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Distance between lower border of symphysis pubis to the tip of

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coccyx.
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Transverse diameter (bispinous- 11 cm)

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Distance between the inner borders of ischialtuberosities

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Posterior sagittal diameter (8.5 cm)

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Distance between sacroccygeal joint and anterior margin of anus.

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111. Most suitable type of pelvis in female ?

a) Gynaecoid
b) Android
c) Anthropoid
d) Platypelloid
Correct Answer - A
Ans. A. Gynaecoid
Gynaecoid pelvis round in shape & is most spacious.
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112. Which pelvis is associated with DTA ?

a) Android
b) Antrhropoid
c) Platypelloid
d) Gynaecoid
Correct Answer - A
Ans. A. Android om
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113. In obstructive labor most important

parameter is?
a) Diameter of pelvic inlet
b) Diameter of pelvic outlet
c) Biparietal diameter
d) Bitemporal diameter
Correct Answer - B
Ans. B. Diameter of pelvic outlet
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The narrowest diameter for the fetus to pass through is pelvic outlet.
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114. Maximum diameter that passed through

maternal pelvis ?
a) Suboccipital bregmatic
b) Biparietal
c) Suboccipital frontal
d) Occipito frontal
Correct Answer - B
Ans, B. Biparietal
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Occipitofrontal is large diameter and deflexed head may complicate
as deep transverse arrest and obstructed labour.
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face to pubis delivery.

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Mento-vertical is the largest diameter but it cannot pass through the

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maternal pelvis.
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115. Semen examination can be done ?

a) Immediately in semi solid form
b) After liquefaction
c) Within 15-30 minutes of liquefaction
d) 11/2 - 2 hr irrespective of liquefaction
Correct Answer - D
Ans. D. 11/2 - 2 hr irrespective of liquefaction
Semen analysis
Best specimen obtained by masturbation
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3-5 days of abstinence is best, not more than that

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Specimen should be examined within 1 1/2 - 2hr

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Liquefaction usually completes within 15-20 min and if delayed it

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indicates prostatic dysfunction. Thus during semen analysis timing of

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liquefaction is important but timing of analysis is not set according to

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liquefaction.
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116. Lithotomy position increases vaginal

opening by how many cm -
a) 1cm
b) 2cm
c) 3cm
d) 4cm
Correct Answer - B
Ans. B. 2cm
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In dorsal lithotomy position, the antero-posterior diameter of the
outlet may be increased to 1.5-2 cm.
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Furthermore, the coccyx is pushed back while the head ilescends

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down to the perineum.

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117. Endometrial biopsy is usually done at ?

a) Just before menstruation
b) 10-12 days after menstruation
c) Just after menstruation
d) At the time of ovulation
Correct Answer - A
Ans. A. Just before menstruation om
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118. Oligomenorrhoea means ?

a) Cycle < 20 days
b) Cycle more than 45 days
c) Cycle more than 28 days
d) Cycle more than 35 days
Correct Answer - D
Ans. D. Cycle more than 35 daysnee om
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119. Magnification obtained by colposcopy is

?
a) 1-2 times
b) 5-6 times
c) 15-25 times
d) 10-20 times
Correct Answer - D
Ans. D. 10-20 times
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Colposcope provides a magnification of 10-20 times.
Colpomicroscopeprovides a magnification 100-300 times.
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120. On which day LH & FSH should be

measured ?
a) 1-3rd day
b) 7th day
c) 14th day
d) 10th day
Correct Answer - A
Ans. A. 1-3rd day
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Level of the hormone FSH, LH and estradiol arc measured on day 3

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in infertility workup.
An elevated FSH level on day 3 is an indication of poor ovarian
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reserve.
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Hormonal assessment FSH/LH developingfollicle producesestrogen

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which signals the hypothalamus to increase or reduce the amount of

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FSH produced by the pituitary gland. When good follicles are not
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developingestrogen levels are lower and more FSH is produced.

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This leak to higher level of FSH on day 3.

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Day 3 FSH fertility test b not the only parameter used to assess
ovarian reserve.
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121. Best parameter for estimation of fetal

age by ultrasound in 3rd trimester is ?
a) Femur length
b) BPD
c) Abdominal circuference
d) Intraoccular distanc
Correct Answer - A
Ans. A. Femur length
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Best parameters for estimation of fetal age by ultrasound
1st trimester – Crown Rump length (CRL)
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2nd trimester - Corrected biparietal diameter (cBPD) or head

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circumference (HC)
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3d trimester - Head circumference and femur length

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Overall - Crown rump length

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122. Commonest variety of compound

presentation is ?
a) Head with hand
b) Head with foot
c) Head with both foot
d) Head, hand & foot
Correct Answer - A
Ans. A. Head with hand
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When a cePhalic presentation is complicated by the presence of a
hand or a foot or both alongside the head or presence of one orboth
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hands by the side of the breech it is called compound presentation.

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Commonest variety of compound presentation - Head with hand

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Rarest variety of compound presentation - Head with hand and foot

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both.
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123. Hegar sign?

a) Uterine contraction
b) Quickening
c) Bluish discoloration of vagina
d) Softening of isthmus
Correct Answer - D
Ans. D. Softening of isthmus
Hegars sign
Present in 2/3 of cases.
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Demonstrated in 6-10 week

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Signs is based on the fad that:

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1. Upper part of the body of the uterus is enlarged by growingfetus.

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2. Lower part of the body is empty and extremely soft (just above the
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cervix)
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3. Cervixis comparatively firm.

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Because of variation in consistent on bimanual examination (two

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fingers in anterior fornix and the abdominal fingers behind the

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uterus) the abdominal and vaginal fingers seem to oppose below

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thebody of the uterus.
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124. Pregnant women going for long journey

& prolonged sitting is associated with
danger of ?
a) Thromboembolism
b) Seat belt compression
c) Preterm labor
d) Bleeding
Correct Answer - A
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Ans. A. Thromboembolism
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Prolonged sitting in car or aeroplane is avoided due to venous stasis

or thromboembolism.
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125. Head of baby is removed in breech

delivery by which maneuver ?
a) Lovsets maneover
b) Pinards maneover
c) Prague
d) Burn Marshall method
Correct Answer - D
Ans. D. Burn Marshall method
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126. Prague manuever is used for ?

a) After coming head in breech
b) Deep transverse assest
c) Extraction of extended arms
d) External cephalic version
Correct Answer - A
Ans. A. After coming head in breech
Sometimes the head rotatesposteriorly so, that the face is behind
the pubis.
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Delivery in this position is difficult and 'Prague maneuver' may be

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tried.
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127.
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Trial of labour in previous casearian section

can be done in ?
a) Placenta previa type III
b) Previous two classical casearian section
c) Suspected CPD
d) Previous caesarian section with adequate pelvis
Correct Answer - D
Ans. D. Previous caesarian section with adequate pelvis
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Adequate pelvis is an indication oftrial oflabour.
Other three options are contraindications.
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128. Hematoma during labour is not due to ?

a) Improper haemostasis
b) Extension of cervical laceration
c) Rupture of paravaginal venous plexus
d) Obliteration of dead space while suturing vaginal wall
Correct Answer - D
Ans. D. Obliteration of dead space while suturing vaginal wall
Failure of obliteration of dead space causes hematoma (not
obliteration of dead space).
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129. Treatment of jaundice in third trimester ?

a) Termination of pregnancy
b) Termination at 42 weeks
c) Termination at 38 weeks
d) Wait for spontaeous labour
Correct Answer - C
Ans, C. Termination at 38 weeks
In patients of intrahepatic cholestasis of pregnancy there is
increased perinatal mortality.
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Hence fetal surveillance is done with biweekly NST.

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Conventional antepartum testing does not predict fetal mortality as

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there is sudden death in cholestasis due to acute hypoxia.

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Hence delivery is recommended at 37-38 weeks.

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In those patients with jaundice with S bilirubin > 1.8 mg%,

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termination ofpregnancy should be done at 36 weeks.

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130. Rate of turnover of amniotic fluid is ?

a) 500 cc/h
b) 1L/hr
c) 1500 cc/h
d) 2L/h
Correct Answer - A
Ans. A. 500 cc/h
Specific gravity of Amniotic fluid: 1.008 to 1.010
Osmolality: 250 mosm/L
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Completely replaced in 3 hours.

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Rate of amniotic fluid turn over is 500cc/hr.

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131. Maximum amount of amiotic fluid is seen

at how many weeks ?
a) 16
b) 30
c) 12
d) 38-40
Correct Answer - D
Ans. D. 38-40
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132. Uterus post pregnancy becomes a pelvic

organ in?
a) 4 weeks
b) 6 weeks
c) 12 weeks
d) 2 week
Correct Answer - D
Ans, D. 2 week
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By the end of 2 weeks - uterus is a pelvic organ.
By the md of 6 week - uterus returns almost to its normal size (pre
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pregnant size).
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133. Assisted head delivery is done in ?

a) Brow presentation
b) Face presentation
c) Persistent occipito posterior position
d) Twin presentation 1522. % of
Correct Answer - C
Ans. C. Persistent occipito posterior position
Occipito posterior positions
"In practice about 5-1O% of women admitted in labourwith cephalic
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presentations present with occipito-posterior presentations.

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Given time and patience, many of these will rotate and get corrected
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to occipito-anterior position and deliver normally.

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134. % of women delivering on their EDD is ?

a) 25%
b) 50%
c) 4%
d) 15%
Correct Answer - C
Ans. C. 4%
Based on the Noegelesfomulalabour starts approximately on: -
Expected date – 4%
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135. Inner cell mass differentiates into ?

a) Chorion
b) Trophoectoderm
c) Embryo
d) All of the above
Correct Answer - C
ANs. C. Embryo
Blastocyst enlarges & the zonapellucida undergoes lysis , this is
called zona hatching.
om
The cells on the outer side become trohoectoderm which

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differentiates into chorion.

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The cells on the inner side form inner cell mass which differentiates
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into embrvo.
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136. Embryo is called "fetus" after how many

weeks post fertilization/conception ?
a) 6
b) 8
c) 10
d) 12
Correct Answer - B
Ans. B. 8
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Embryonic period begins at 3rd week following ovulation/fertilization
& extends upto 8 weeks post conception (10 weeks from LMP).
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Fetal period begins after 8 weeks post conception (10 weeks from
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LMP) & ends in delivery.

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137. Utero-placental circulation is

established days after fertilization ?
a) 5
b) 10
c) 15
d) 20
Correct Answer - B
Ans. B. 10
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The uteroPlacental circulation is established 9-10 days after
fertilization.
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Fetoplacental circulation is established 2l days post fertilization.

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138. Pregnancy is contraindicated in all of the

following except -
a) Primary Pulmonary Hypertension
b) Eisenmenger's syndrome
c) Marfan's with aortic root dilation
d) WPW syndrome
Correct Answer - D
Ans, D. WPW syndrome
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139. Which heart disease has the worst

prognosis/maximum mortality in
pregnancy?
a) MS
b) AS
c) PDA
d) Eisenmenger's syndrome
Correct Answer - D
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Ans. D. Eisenmenger's syndrome

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140. Ovarian cycle can be correlated with all

except ?
a) Endometrial sampling
b) Vaginal cytology
c) Blood hormonal levels
d) Estrous cycle
Correct Answer - D
Ans. D. Estrous cycle
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Estrous cycle does not occur in human beings.
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141. Endometrial biopsy to detect ovulation is

done on which day of the menstual cycle
?
a) Day 8-9
b) Day 13-15
c) Day 21-23
d) Day 3-5
Correct Answer - C
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Ans. C. Day 21-23

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Endometrial Biopsy : Rarely done now a days for the purpose of

iletecting ovulation.
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142. The uterine blood flow at term is -

a) 50 mL/min
b) 100-150 mL/min
c) 350-375 mL/min
d) 500-750 mL/min
Correct Answer - D
Ans. D. 500-750 mL/min
Uteroplacental blood flow increases progressively during pregnancy
and ranges from 5N)-800 mL/minat term.
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143. Godell's sign is ?

a) Dusky hue of the vestibule
b) Softening of the cervix
c) Increased pulsations felt through the lateral fornices
d) Regular and rhythmic contractions during bimanual examination
Correct Answer - B
Ans. B. Softening of the cervix om
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144. In fetus, insulin production begin at

weeks of gestation -
a) 4-6
b) 8-12
c) 14-18
d) 24-28
Correct Answer - B
Ans. B. 8-12
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Reaching 8 to 10 weeks into development, the pancreas starts
producing insulin, glucagon, somatostatin, and pancreatic
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polypeptide.
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145. Limb bud appear at what weeks of

gestation?
a) 3
b) 4
c) 6
d) 9
Correct Answer - B
Ans. B. 4
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The upper extremity is first discretely visible as a bulge or limb bud
that develops on the ventrolateral wall of the embryo on day 26 (4-
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mm crown-to-rump length).
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146. Features of non severe/mild pre

ecampsia are all ecxept -
a) Diastolic BP <100 mm Hg
b) Systolic BP< 160 mm Hg
c) Mild IUGR
d) No premonitory symptoms
Correct Answer - C
Ans., C. Mild IUGR
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147. FERNING is due to ?

a) Estogen & sodium chloride
b) Progesterone & sodium chloride
c) HCG
d) All of the above
Correct Answer - A
Ans, A, Estogen & sodium chloride
Cervical mucus is relatively rich in sodium chloride when estrogen
(but not progesterone) is being produced.
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148. Second wave of trophoblastic invasion

occurs at weeks of gestation?
a) 8-11
b) 10-12
c) 12-15
d) 16-20
Correct Answer - C
Ans, C. 12-15
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The timing of the development of the uteroplacental vessels has
been described in waves, or stages, over the course of gestation.
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The first wave occurs before 12 weeks post-fertilization and consists

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ofinvasion and modification of the spiral arteries of the decidua.

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Between 12 and 16 weeks pos-fertilization, the second wore occurs.

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This involves invasion of the intramyometrial parts of the spiral

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arteries, converting narrow lumen, muscular spiral arteries into

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dilated, low-resistance uteroplacental vessels.

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149. Abstinence period before semen

analysis is ?
a) 1-2 days
b) 3-5 days
c) 5-7 days
d) 7-9 days
Correct Answer - B
Ans. B. 3-5 days
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The ideal specimen for examination is after 3-5 days of abstinence.
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150. Engaging diameter in face presentation

is -
a) Suboccipitobregmatic
b) Mentovertical
c) Submentobregmatic
d) Occipitofrontal
Correct Answer - C
ANs, C. Submentobregmatic
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151. Least likely to cause dysmenorrhea -

a) Endometriosis
b) Adenomyosis
c) Uterine polyp
d) Cervical polyp
Correct Answer - D
Ans, D. Cervical polyp om
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152. LH surge is due to ?

a) Progesterone
b) Estrogen
c) AMH
d) All of the above
Correct Answer - B
Ans, B. Estrogen
3-4 days before the ovulation, estrogen level crosses a certain limit
(threshold level).
om
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153. Menopause is defined as ?

a) Presence of hot flushes
b) Cessation of menses for 1 year
c) Cessation of menses for 6 months
d) Cessation of menses for 2 years
Correct Answer - B
Ans, B. Cessation of menses for 1 year
Menopause is defined as the permanent cessation of menses for 7
year and is physiologically correlated with the decline in estrogen
om
secretion resulting from the loss offollicular/ovarian function.

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154. Symptoms of menopause are all except ?

a) Hot flushes
b) Night sweats
c) Decrease libido
d) Intermittent hypotension
Correct Answer - D
Ans, D. Intermittent hypotension
Hot flushes
The classic symPtom associated with estrogen deficiency is the hot
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flash, also known as hot flush

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This symptom is described as 'recurrent, transient periods of

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flushing, sweating and a sensation ofheat, often accompanied by

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palpations, feeling of anxiety and sometimes followed by chills".

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155. MENOPAUSE is diagnosed by ?

a) Estradiol <20 pg/ml
b) Progesterone <40 ng/dl
c) FSH>40 IU/L
d) LH > 20 IU/L
Correct Answer - C
Ans, C. FSH>40 IU/L
As per the American Association of clinical Endocrinologists, the
diagnosis of menopause is confirmed by FSH levels >40 IU/L.
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156. The velocity of sperm is ?

a) 1-2 cm/hr
b) 2-4 cm/min
c) 1-4 mm/min
d) 1-4 mm/hr
Correct Answer - C
Ans. C. 1-4 mm/min
The velocity of a sperm in fluid medium is usually 1-4 mm/min.
This allows the sperm to move towards an ovum in order to fertilize
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it.
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157. After ejaculation semen liquefies in ?

a) 10 minutes
b) 30 minutes
c) 75 minutes
d) 120 minutes
Correct Answer - B
Ans. B. 30 minutes
Following ejaculation, the semen forms a gel which provides
protection for the sperm from the acidic environment of the vagina.
om
The gelisliquefied within 20-30 minute by enzymes from the prostate

r.c
gland.
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158. During pregnancy, true statement about

CVS is ?
a) Cardiac output decreases
b) Right axis deviation
c) Increase in left ventricular end diastolic diameter
d) All of the above
Correct Answer - C
Ans, C. Increase in left ventricular end diastolic diameter
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2D echo: Increase in left ventricular end diastolic diameter.
Increase in left and right atrial diameters.
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159. MC site of implantation is ?

a) Fallopian tube amullary part
b) Fallopian tube isthmus
c) Fundus of uterus
d) Cornu of uterus
Correct Answer - C
Ans, C. Fundus of uterus
Implantation occurs in the endometrium on the anterior or posterior
wall of the body near the fundus on the sixth day following
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fertilization (corresponding to the 20th day of the menstrual cycle).

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160. Alpha subunit of hCG is similar to ?

a) FSH
b) LH
c) TSH
d) All of the above
Correct Answer - D
Ans, D. All of the above
Human chorionic Gonadotropin (hcG) isstructurallyrelated to three
other glycoproteinhormones LH, FSH, and TSH.
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161. Placental hormone with highest

carbohydrate content is -
a) HCG
b) Human pregnancy specific beta glycoprotein
c) HPL
d) Relaxin
Correct Answer - A
Ans, A. HCG
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HCGhas the highest carbohydrate content of any human hormone-
30%.
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162. The pelvic inlet usually is considered to

be contracted if its shortest
anteroposterior diameter is less than -
a) 12 cm
b) 10 cm
c) 8 cm
d) 14 cm
Correct Answer - B
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Ans. B. 10 cm
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The pelvic inlet usually is considered to be contracted if its shortest

anteroposteriordiameter is less than10 cmor if the greatest
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transverse diameter isless than12 cm

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163. Azoospermia with normal FSH would

indicate ?
a) Hypothalamic failure
b) Testicular failure
c) Obstruction of vas defrens
d) All of the above
Correct Answer - C
Ans, C, Obstruction of vas defrens
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164. Causes of male infertility ?

a) Idiopathic
b) Varicocele
c) Yq 11 micro deletion
d) All of the above
Correct Answer - D
Ans, D. All of the above om
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165. Fetal thyroid gland is able to synthesize

hormones by weeks of gestation ?
a) 6-7
b) 7-8
c) 10-12
d) 12-14
Correct Answer - C
Ans, C. 10-12
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Fetal thyroidglandisabletosynthesizehormonesby 10-12
weeksofgestation.
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166. Poor prognosis in first trimester USG is

?
a) No fetal pole at 5 weeks
b) No cardiac activity at 5 weeks
c) No gestational sac at 4 weeks
d) No cardiac activity at 8 weeks of gestation
Correct Answer - D
Ans, D. No cardiac activity at 8 weeks of gestation
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Absence of embryo with heartbeat 22 weeks after a scan that
showed a gestational sac without a yolk sac
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167. All are true about post partum

depression except -
a) Symptoms resolve in 10-12 days
b) Affects both sexes
c) SSRIs are effective
Correct Answer - A
Ans, A. Symptoms resolve in 10-12 days
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168. Nerve injured in McRoberts maneuver is

?
a) Lumbosacral trunk
b) Obturator nerve
c) Femoral nerve
d) Pudendal nerve
Correct Answer - C
Ans, C. Femoral nerve
om
McRoberts maneuver is to be done in cases of shoulder dystocia.
When the maternal thighs are markedly flexed and abducted,
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pressure from the overlying inguinal iigament may lead to femoral

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nerve injury.
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169. Most conclusive clinical sign of

pregnancy is ?
a) Uterine enlargement
b) Cervical softening
c) Amenorrhea
d) Fetal heat sound auscultation
Correct Answer - D
Ans. D. Fetal heat sound auscultation
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FHS auscultation is the most conclusive clinical sign of pregnancy.
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170. CRL when cardiac activity can be

detected earliest by TVS -
a) 1-4mm
b) 1 cm
c) 6-7mm
d) 2-4 cm
Correct Answer - A
Ans, A. 1-4mm
om
Fetal heart beat can be detected as early as just under 6 weeks
gestation on good quality, high frequency transvaginalultrasound, as
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a crown rump length (CRL) of as little as 1-2 mm.

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171. Kamla, 30 years old, P2L2 with 3.2 x 4.1

cm fibroid uterus, complains of
menorrhagia and is on symptomatic
treatment since 6 months. The patient
refuses surgery. Next line of
management is ?
a) GnRH analogs
b) Danazol
c) Myomectomy
d) Uterine artery embolization

om
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Correct Answer - D
Ans, D. Uterine artery embolization
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UAE can be used as a therapy for symptomatic patients who refuse

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or want to avoid surgery.

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After embolization, there is 60-65% decrease in size of fibroids over

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decrease or disaPPear.
If the patient is still symptomatic after 1 year, then surgery should be
considered.
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172. Living ligature of the uterus is ?

a) Endometrium
b) Middle layer of myometrium
c) Inner layer of myometrium
d) Parametrium
Correct Answer - B
Ans, B. Middle layer of myometrium
Middle crisscross fibres act as living ligature during involution of the
uterus and prevent blood loss.
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173. In partograms recommended by 'WHO'

the distance between the alert and action
lines is ?
a) 1 hour
b) 2 hours
c) 4 hours
d) 5 hours
Correct Answer - C
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Ans. C. 4 hours
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The concept of alert line' and ‘action line’ was introduced by Philpott
and Castle in 1972.
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The action line can be placed at 2 – 4 hours interval to the right and
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parallel to alert line.

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In partograms recommended by'WH0'the distancebetween the alert

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and action lines is 4 hours.

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174. Surgical excision of corpus luteum

before weeks of gestation, results in
miscarriage
a) 6-7
b) 9-11
c) 11-12
d) 12-14
Correct Answer - A
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Ans, A, 6-7
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Surgical excision of corpus luteum (luteoctomy) before 7 weeks of

gestation, uniformly precipitated an abrupt decrease in serum
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progesterone concentration followed by miscarriage

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175. Factors responsible for development of

OHSS include ?
a) Histamine
b) Cytokines
c) Vascular Endothelial Growth Factor
d) All of the above
Correct Answer - D
Ans, D. All of the above
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VEGF is considered to be the most important.
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176. MVA syringe is used for ?

a) First trimester MTP
b) 2nd trimester MTP
c) Vacuum delivery
d) All of the above
Correct Answer - A
Ans, A, First trimester MTP
Manual vacuum aspiration (MvA) is a safe and effective method of
abortion that involves evacuation of the uterine contents by the use
om
of a hand-held plastic aspirator.

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It is appropriate for treatment of incomplete abortion for uterine sizes

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up to 12 weeks from the last menstrual period (including

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miscarriage, spontaneous abortion and removal of retained products

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from an induced abortion), first-trimester MTP and endometrial

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biopsy.
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177. Diihrssen incision is taken on -

a) Fallopian tube
b) Ovary
c) Incompletely dilated cervix
d) Fully dilated cervix
Correct Answer - C
Ans, C, Incompletely dilated cervix
Occasionalln especially with small preterm fetuses, the incompletely
dilated cervix will not allow vaginal delivery of the after-coming head
om
ofthe breech.
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In such cases, Duhrssen incisions are usually necessary (cut the

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cervix at l0 and 2 o'clock positions).

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178. A 27-year-old female with placenta previa

had severe bleeding. What is the most
likely outcome post delivery?
a) Galactorrhea
b) Diabetes
c) Absence of menstrual cycle
d) Cushing syndrome
Correct Answer - C
om
Ans. c. Absence of menstrual cycle

r.c
Sheehan syndrome, also known as postpartum hypopituitarism or

postpartum pituitary necrosis, is hypopituitarism caused by necrosis
ke
due to blood loss and hypovolemic shock during and after childbirth.
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Most common initial symptoms of Sheehan syndrome are

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agalactorrhea (absence of lactation) under difficulties with lactation.

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Many women also report amenorrhea or oligomenorrhea after

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179. Woman has 100 ml blood loss every 30

days. This is called as ?
a) Menorrhagia
b) Polymenorrhea
c) Hypomenorrhea
d) Normal menses
Correct Answer - A
Ans. A. Menorrhagia
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Normal blood loss during menses is around 35 ml (20-80 ml)
Blood loss more than 80 ml is menorrhagia
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180. Menometrorrhagia is ?
a) Heavy periods
b) Intermenstrual bleeding
c) Heavy & irregular bleeding
d) Uterine bleeding occurring at regular intervals of less than 21

days
Correct Answer - C
Ans. C. Heavy & irregular bleeding
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181. Prevalence of breech presentation at full

term is ?
a) 10%
b) 6-7%
c) 3-4%
d) 1-2%
Correct Answer - C
Ans. C. 3-4%
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182. The shortest conjugate is ?

a) True conjugate
b) Obstetric conjugate
c) Diagonal conjugate
d) Anatomical conjugate
Correct Answer - B
Ans. B. Obstetric conjugate
Obstetric conjugate (10 cm)
Distance between midpoint of sacral Promontory to the prominent
om
bony projection in the midline on inner surface of symphysis pubis.

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183. Shortest transverse diameter is ?

a) BPD
b) Bitemporal diameter
c) Bimastoid diameter
d) All are equal in length
Correct Answer - C
Ans. C. Bimastoid diameter
Bimastoid diameter = 7.5 cm
Occipitofrontal diameter → 11.5 cm
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184. With reference to fetal heart rate, a

nonstress test is considered reactive
when?
a) Two fetal heart rate accelerations are noted in 20 minutes
b) One fetal heart rate acceleration is noted in 20 minutes
c) Two fetal heart rate accelerations are noted in 10 minutes
d) Three fetal heart rate accelerations are noted in 30 minutes
Correct Answer - A
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Ans. A. Two fetal heart rate accelerations are noted in 20

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minutes
Reactive (Reassuring) NST
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Two or more accelerations of > 15 beats/minute above the baseline,

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lasting for > 75 seconds arc present in 20-4O minutes observation

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185. Variable deceleration is seen in ?

a) Head compression
b) Uteroplacental insufficiency
c) Cord compression
Correct Answer - C
Ans, C. Cord compression
Variable decelerations are due to cord compression
(oligohydramnios in labor)
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186. Modified BIOPHYSICAL PROFILE is ?

a) NST + FETAL TONE
b) FETAL TONE + AFI
c) NST + AFI
d) NST+ FETAL TONE + AFI
Correct Answer - C
Ans, C. NST + AFI
Modified BPP = NST &AFI
BPP has 5 components
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187. If fetus is having hypoxia, which of the

BPP parameter will be affected last ?
a) Fetal tone
b) Fetal breathing movement
c) Fetal movements
d) NST
Correct Answer - A
Ans. A. Fetal tone
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First activity to appear, Fetal Tone at about 7.5-8.5 weeks, is also
presumably the last activity to disappear with progressively
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worsening hypoxia.
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188. Test used to detect genetic abnormality

in embryo,before transferring it to the
uterus in IVF is ?
a) Embryo cell biopsy
b) CVS
c) ICSI
d) All of the above
Correct Answer - A
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Ans, A. Embryo cell biopsy

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PGD, involves removing a cell from an IVF embryo to test it for a

specific genetic condition (cystic fibrosis' for example) before
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transferring the embryo to the uterus.

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189. In IVF, embryos are transferred back to

uterine cavity at cells stage ?
a) 2
b) 2-4
c) 4-8
d) 8-16
Correct Answer - C
Ans, C. 4-8
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Typically embryos ate transferred at the cleavage stage (Day 2 or 3
after oocyte retrieval).
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Day three embryos ate called cleavage stage embryos and have
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approximately 4 - 8 cells.
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190. Azoospermic patient can be a father of a

child, by which of the following?
a) IUI
b) ZIFT
c) ICSI
d) Not possible & counsel regarding adoption
Correct Answer - C
Ans. C. ICSI
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PESA= percutaneous epididymalsperm aspiration
MESA= microscopic epididymal sperm aspiration
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TESA= testicular sperm asPiration

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TESE= testicular sperm extraction (testicular biopsy)

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191. A primigravida with 36 weeks of

pregnancy is in labor with 3 cm dilatation
and minimal uterine contraction. On
rupture of membranes, fresh bleeding is
noted with late fetal deceleration up to 50
beats/min. The patient was taken for
LSCS but fetus could no be saved. No
abruptio or placenta previa was seen.
The likely diagnosis is ?
a) Placenta previa
b) Revealed abruptio
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c) Circumvallate placenta
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d) Vasa previa
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Ans. D. Vasa previa

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Vasa previa ( l:2500) is a rare condition in which fetal blood vessels

are in front of the presenting part and cross the cervix.
The condition has a high fetal mortality rate (50-95%). This is
attributed to rapid fetal exsanguination, resulting from the vessels
tearing when the cervix dilates, membrane ruPture.
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192. All are components of Active

Management of the Third Stage of Labor
except ?
a) Uterotonic agent within 1 minute of birth
b) Massage of uterus before control cord traction
c) Control cord traction
Correct Answer - B
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Ans. B. Massage of uterus before control cord traction

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Administer anuterotonic drug at the delivery of the anterior shoulder

or afterwards, within one minute of the baby's birth.
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Before performing AMTSL, gently palpate the woman's abdomen to

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rule out the presence of another baby. At this point, do not massage
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the uterus.
irs
Perform controlled cord traction

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Massage the uterus immediately

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193. With which of the following events, the

feto maternal haemorrhage risk is the
least ?
a) Amniocentesis
b) Cordocentrsis
c) Chorionic villus sampling
d) Abruption
Correct Answer - D
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Ans. D. Abruption
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194. Infertility is defined as ?

a) Inability to conceive after 1 year of regular unprotected
intercourse
b) Inability to conceive after 1 year of marriage
c) Inability to conceive after 2 years of marriage
d) Inability to conceive in spite of 2 years of regular unprotected

intercourse
Correct Answer - A
ANS. A. Inability to conceive after 1 year of regular unprotected
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intercourse
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Infertility is defined as an inability to conceive in spite of 1 year of

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regular unprotected intercourse

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195. Cord prolapse is least likely with -

a) Transverse lie
b) Footling breech
c) Oligohydroamnios
d) Floating head
Correct Answer - C
Ans. C. Oligohydroamnios
Cord prolapse has been defined as the descent of the umbilical cord
through the cervix alongside (occult) or past the presenting part
om
(overt) in the vagina or outside the vulva in the presence of ruptured

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membranes
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196. Ideal time to do Glucose challenge test in

pregnancy is ?
a) 12-16 weeks
b) 20-24 weeks
c) 24-28 weeks
d) 30-34 weeks
Correct Answer - C
Ans. C. 24-28 weeks
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O'sullivan Blood Sugar Screening Test (Glucose Challenge Test)
The ideal time to do this test is24-28 weeks of gestation (as insulin
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resistance in pregnancy is maximum at 28 weeks of gestation)

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197. After IUFD, when does the mother

develop DIC -
a) 48 hours
b) 1-2 weeks
c) 3-4 weeks
d) 6 weeks
Correct Answer - C
Ans. C. 3-4 weeks
om
Thromboplastin from the dead fetus can enter the maternal system
and cause DIC.
r.c
This only happens when the dead fetus is retained inside for 3-4
ke
weeks.
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198. Folic acid required in first trimester of

normal pregnancy -
a) 100 microgram
b) 400-500 microgram
c) 4 mg
d) 5 mg
Correct Answer - B
Ans, B, 400-500 microgram
om
Some NTDs are associated with a specific mutation in the
methylene tetrahydrofolatereductase gene, the adverse effects of
r.c
whichcan be largely overcome by periconceptional folic acid

ke
supplementation.
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More than half of NTDs could be prevented with daily intake of 400
tR
microgram of folic acid throughout the periconceptional period.

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A woman with a prior pregnancy complicated by a neural tube defect

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can reduce the 23% recurrence risk by more than 70% if she takes 4
w
mg of folic acid for the month before conception and for the first
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trimester of pregnancy.
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199. A 30-year-old is 14 weeks pregnant. She

had two painless deliveries at 16 weeks
earlier. Next line of management is ?
a) Cervical encerclage
b) Evaluation for diabetes mellitus and thyroid disorders
c) Cervical length assessment
d) Tocolytics
Correct Answer - C
om
Ans, C. Cervical length assessment

r.c
The patient had two painless abortions at 16 weeks in the past, so

mostly it is a case of incompetent os.
ke
Next line of management in these patients is frequent cervical length

an
assessment: clinically or by USG.

tR
The patient is evaluated more frequently and if the cervix is short

irs
(less than 2.5cm) than cervical encerclage has to be done.

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Cervical encerclage is the surgery ofchoice for incompetent os, but

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the surgery itselfcan lead to complications such as uterine

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contractions, abortions, and PROM.

So the surgery is only to be done if it is indicated.
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200. Upper two -third anterior vaginal wall

prolapse is ?
a) Cystocele
b) Urethrocele
c) Rectocele
d) Enterocele
Correct Answer - A
Ans. A. Cystocele
om
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201. Earliest sign after IUFD is ?

a) Overlapping of skull bones
b) Hyperflexion of spine
c) Gas in great vessel
d) Over crowding of ribs
Correct Answer - C
Ans. C. Gas in great vessel
Robert sign (gas in great vessels) - 12hrs after death.
om
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202. True about Gartners cyst is ?

a) Retention cyst in remnants of Wolffian duct
b) Arises from mullerian duct
c) Commonly arises from cervix
d) Impulse on coughing
Correct Answer - A
Ans, A. Retention cyst in remnants of Wolffian duct
om
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203. If the anal spincter is injured, it is which

degree of Perineal Tear ?
a) First
b) Second
c) Third
d) Fourth
Correct Answer - C
Ans, C. Third
om
Perineal Tears are classified into four categories
First-degree tear: laceration is limited to the fourchette and
r.c
superficial perineal skin or vaginal mucosa.

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Second-degree tear: laceration extends beyond fourchette,

an
perinealskin and vaginal mucosa to perineal muscles and fascia, but

tR
not the anal sphincter.

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Third-degree tear: fourchette, perineal skin, vaginal mucosa,

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muscles, and anal sphincter are torn

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204. If the rectal mucosa is injured, it is which

degree of Perineal Tear ?
a) First
b) Second
c) Third
d) Fourth
Correct Answer - D
Ans, D. Fourth
om
Rectal mucosal tear is fourth degree tear.
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205. Cryptomenorrhea occurs in ?

a) Fibroids
b) PCOS
c) Imperforate hymen
d) All of the above
Correct Answer - C
Ans, C. Imperforate hymen
Congenital
Imperforate hymen: It is due to failure of disintegration of the central
om
cells of Mullerian eminence that project into urogenital sinus

r.c
TransversevaginalsePtum
ke
Atresia ofvagina, cervix.

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206. Best indicator for ovarian reserve is ?

a) AMH
b) LH/FSH ratio
c) FSH
d) Estradiol
Correct Answer - A
Ans. A. AMH
AMH blood levels are thought to reflect the size of the remaining egg
supply or “ovarian reserve"
om
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207. HPL has activity similar to which

hormone ?
a) Oxytocin
b) Growth hormone
c) Insulin
d) All of the above
Correct Answer - B
Ans. B. Growth hormone
om
Human placenta lactogen (hPL) was named so, because of its
potent lactogenic & growth hormone like bioactivity as well as
r.c
immunochemical resemblance to human growth hormone'

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208. Which of the following is not a soft

tissue marker of Down syndrome on
USG ?
a) Increase NT
b) Absent nasal bone
c) Exomphalos
d) Polydactyly
Correct Answer - D
om
Ans. D. Polydactyly
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209. In a case of recurrent spontaneous

abortion the following investigation is
unwanted ?
a) Hysteroscopy
b) Testing for antiphospholipid antibodies
c) Testing for TORCH infections
d) Thyroid function tests
Correct Answer - C
om
Ans. C. Testing for TORCH infections

r.c
Testingfor TORCH infections is now thought to be unwarranted.

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210. Dilatation & evacuation is done for all

ecxept ?
a) Inevitable abortion
b) Incomplete abortion
c) Threatened abortion
Correct Answer - C
Ans. C. Threatened abortion
om
Inevitable abortion means the process ofexpulsion ofproducts
ofconception has become irreversible. The expulsion of products of
r.c
conception has not occurred but it is bound to happen and nothing

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can be done to stop this process.

an
When the entire products are not expelled, part of it is left inside the
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uterine cavity, it is called incomplete abortion.

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211. WHO normal Hb value for a non pregnant

adult female is ?
a) 10 gm/di
b) 11 gm /dl
c) 12 gm/dl
d) 13 gm/dl
Correct Answer - C
Ans. C. 12 gm/dl
om
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212. Outcomes of occipito posterior position?

a) Deep transverse arrest
b) Occipito sacral arrest
c) Face to pubis delivery
d) All of the above
Correct Answer - D
Ans, D. All of the above om
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213. RMP can perform MTP in first trimester if

he has assisted in MTPs -
a) 5
b) 15
c) 25
d) 50
Correct Answer - C
Ans, C. 25
om
A registered medical practitioner shall have one or more of the
following experience or training in gynecology and obstetrics namely
r.c
=
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If he has assisted a registered medical practitioner in the

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performance of twenty-five cases of medical termination

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ofpregnancy of which at least five have been performed

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independently,
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214. Crying of fetus in utero is called as ?

a) Vagitus uterinus
b) First cry
c) Utero vaginalis
d) Vagitus vagina
Correct Answer - A
Ans, A. Vagitus uterinus om
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215. True about cephalhematoma is :

a) Crosses the suture lines
b) Always present at birth
c) Ventouse delivery is a risk factor
d) All of the above
Correct Answer - C
Ans. C. Ventouse delivery is a risk factor
The usual causes of a cephalohematoma are a prolonged second
stage of labor or instrumental delivery,particularly ventouse.
om
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216. All are causes of anovulatory

amenorrhoea except?
a) PCOD
b) Hyperprolactemia
c) Gonadal dysgenesis
d) Drugs
Correct Answer - C
Ans. C. Gonadal dysgenesis
om
Causes of anovulatory amenorrhea
PCOD
r.c
Hyperprolactinaemia
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Weight loss, stress, exercise

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Drugs
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Chest wall stimulation

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217. What is false about post menopausal

state ?
a) Low LH
b) Low estrogen
c) High FSH
d) High androgen
Correct Answer - A
Ans. A. Low LH
om
Hormonal changes in post-menoPausal state
FSH level is increased
r.c
Oestrogen level is decreased & most of it is synthesised peripherally

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by conversion of androgen to oestrogen

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Androgen level is slightly increased

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218. In a postmenopausal female, which

hormone increases?
a) FSH
b) Estrogen
c) GH
Correct Answer - A
Ans, A. FSH
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219. Role of lactobacilli in vaginal secretions

a) To maintain alkaline pH
b) To maintain acidic pH
c) Nutrition
d) None
Correct Answer - B
Ans., B. To maintain acidic pH
The importance of Doderlein's bacillus is that its presence is
associated with production of lactic acid contained in the vaigna and
om
this acidity inhibits the growth of other organisms."

r.c
Doderlein's bacillus is the only organism which will grow at the pH of

ke
4-4.5 (normal pH of vagina).

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220. Hegar sign all are true except ?

a) Bimanual palpation method
b) Difficult in obese
c) Can be done at 14 weeks
d) Present in 2/3rd of cases
Correct Answer - C
Ans. C. Can be done at 14 weeks
Hegar's sign: Present in2/3rd of cases. Demonstrated between 6-10
weeks, a little earlier in multipara. This sign is based on the 2 facts
om
(1) upper part of the body of uterus is enlarged by growing uterus

r.c
and lower part is empty and soft and cervix is comparatively film.
ke
Therefore on bimannual examination (2 fingers in the anterior fornix

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and abdominal fingers behind the uterus), abdominal and vaginal

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fingers seem to appose below the body ofthe uterus.

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221. Hegar sign is seen in how many weeks ?

a) 6-10 weeks
b) 10-14 weeks
c) 14-18 weeks
d) 18-22 weeks
Correct Answer - A
Ans. A. 6-10 weeks om
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222. Palmer sign is related to ?

a) Contraction of uterus
b) Dusky hue of ant vaginal wall
c) Bluish discolouration of ant vaginal wall
d) Increased pulsations felt through lateral fornix
Correct Answer - A
Ans, A, Contraction of uterus
Palmer sign:-regular and rhythmic contractions can be elicited during
bimanual examination as early as 4-8 weeks.
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223. New born can be given breast milk after

how much time following normal
delivery?
a) Half hour
b) 1 hours
c) 2 hours
d) 3 hours
Correct Answer - A
om
Ans A. Half hour

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A healthy baby is put to the breast immediately or at most % to 1 hr

following normal delivery.
ke
Following caesarean sections a period of 4-6 hours may be sufficient

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for the mother to feed her baby.

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224. 4 month amenorrhoea with increased

FSH, LH & decreased estrogen in a 35
yrs old?
a) Premature menopause
b) Menopause
c) Late menopause
d) Perimenopause
Correct Answer - A
om
Ans, A. Premature menopause

r.c
Premature menopause is defined as ovarian failure occurring 2 SD

in years before the mean menopausal age in a population.
ke
It is clinically defined as secondary amenorrhea for at least 3 months

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with raised FSH level, raised FSH:LH ratio & low E2 level in a
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women under 40 yrs of age."

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225. 35 yr old with 4 months amenorrhea with

increased FSH, decreased estrogen.
What is the diagnosis?
a) Premature ovarian failure
b) PCOD
c) Pituitary failure
d) Hypothalamic failure
Correct Answer - A
om
Ans. A. Premature ovarian failure

r.c
It is a case of premature menoPause (premature ovarian failure)'

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226. Contraction stress test false is ?

a) Oxytocin not used
b) Invasive method
c) Detects fetal well being
d) Negative test is associated with good fetal outcome
Correct Answer - A
Ans, A. Oxytocin not used
Contraction stress test (CST) (syn : Oxytocin challenge test):
It is an invasive test to asses fetal respiratory well being during
om
pregnancy.
r.c
It detects alteration in FHR in response to uterine contraction

ke
induced by oxytocin indicating hypoxia.

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Interpretations
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Negative test indicated good outcome

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227. NST, what is seen except?

a) Variability
b) Acceleration
c) Time period
d) Oxytocin
Correct Answer - D
Ans, D. Oxytocin
The non-stress test (NST) measures fetal heart rate, which is
monitored with an external transducer for at least 20 minutes.
om
During fetal movement, tracing is observed for heart rate

r.c
acceleration.
ke
Test is positive if two or more fetal heart rate accelerations occurs in

an
20 minute period.
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228. Menstrual regulation effective upto ?

a) 14 days
b) 21 days
c) 4weeks
d) 6 weeks
Correct Answer - A
Ans, A. 14 days
Menstrual regulation (lnduction/Aspiration)
Aspiration of endometrial cavity within l4 days of missed period in a
om
woman with previous normal cycle.

r.c
Done as an OPD procedure.

ke
Helps to detect failed abortion, molar pregnancy or ectopic

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Pregnancy.
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Contraindicated in advanced pregnancy & in presence of local pelvic

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inflammation.
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229. pH of vagina in pregnant woman is

usually ?
a) 4.0
b) 4.5
c) 5
d) >5
Correct Answer - A
Ans. A. 4.0
om
The vaginal acidity is due to lactic acid.
The normal pH in the healthy women of the child bearing age group
r.c
is 4.5
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230. Vaginal pH before puberty is?

a) 7
b) 6
c) 4.5
d) 5
Correct Answer - A
Ans. A. 7 om
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231. Decidual reaction is due to which

hormone ?
a) Progesterone
b) Estrogen
c) LH
d) FSH
Correct Answer - A
Ans. A. Progesterone
om
Increased structural & secretory activity of the endometrium that
brought about in response to progesterone following implantation is
r.c
known as Decidual reaction".

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232. Inhibin levels are checked on which day

of menstrual cycle ?
a) Day 3
b) Day 4
c) Day 5
d) Day 6
Correct Answer - A
Ans. A. Day 3
om
Ovarian reserve test is designed to assess both the number of
immature eggs in the ovaries and their quality, which gives an
r.c
indication of woman's potential fertility.

ke
It works by detecting the levels of three female hormones,

an
using a blood sample taken on day three of menstrual cycle:

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1. Follicle stimulating hormone (FSH)

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2. Anti-mullerian hormone (AMH)

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3. Inhibin-B
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233. Best test for ovulation ?

a) Serum estrogen
b) Serum progesterone
c) Both
d) None
Correct Answer - B
Ans. B. Serum progesterone
Plasma concentration of progesterone rises after ovulation &
reaches peak of 15 ng/ml at mid luteal phase & then declines as the
om
corpus luteum degenerates".

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234. Cardiac output increases maximum at

which week?
a) 26-28wks
b) 30-32 wks
c) 32-34 wks
d) 34-36 wks
Correct Answer - C
Ans. C. 32-34 wks
om
Cardiac output:
Starts to increase from 5th week of pregnancy, reaches its peak 40-
r.c
50% at about 30-34 weeks.

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235. In pregnancy plasma volume increased

maximum at what gestational age?
a) 10 wks
b) 20 wks
c) 25 wks
d) 30 wks
Correct Answer - D
Ans, D. 30 wks
om
Plasma volume is increased. Starting to increase at 6 weeks &
reaching max upto 50% at 30 weeks. Total plasma volume
r.c
increases to the extent of 1.25 litres.

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236. 5 month pregnant female, which of the

following is true?
a) 50% have soft systolic murmur
b) Cardiac output is reduced
c) Systemic vascular resistance is increased
d) Increase in CVP
Correct Answer - A
Ans. A. 50% have soft systolic murmur
om
Anatomical changes during pregnancy
Heart is pushed upwards & outward. Apex beat is shifted in 4th
r.c
intercostals space.
ke
A systolic murmur can be heard in apical or pulmonary area.

an
Mammary murmur is a continuous hissing murmur audible over

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tricuspid area in left 2nd & 3rd iintercostals space.

irs
ECG shows left axis deviation. 53 and rarely 54 can be heard.

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237. Spinnbarkeit is maximum shown at

which phase?
a) Menstrual phase
b) Ovulatory
c) Post ovulatory
d) Pre follicular
Correct Answer - B
Ans. B. Ovulatory
om
Spinnbarkeit test (Thread test or Fern test)
A sPecimen of cervical mucus when seen under low power
r.c
microscope, shows a characteristic fern formation.

ke
Done to see the estrogenic activity in ovulatory phase of menstrual

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cycle.
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238. Rarest presentation is?

a) Cephalic
b) Breech
c) Shoulder
d) Vertex
Correct Answer - C
Ans. C. Shoulder om
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239. Fertile period of female is measured by ?

a) LH
b) FSH
c) Estrogen
d) Oxytocin
Correct Answer - A
Ans, A. LH
"LH surge from the anterior pituitary gland occurs 24 hours prior to
ovulation. Radioimmunoassays of the morning sample of urine &
om
blood gives results in 3 hours. Not only does the LH surge help in
r.c
predicting ovulation, but the approximate time of ovulation can be

ke
gauged & coitus around this time can improve the chances of
an
conception."
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240. External version is done after?

a) 34 weeks
b) 36 weeks
c) 38 weeks
d) 40 weeks
Correct Answer - B
Ans. B. 36 weeks
The maneuver is carried out after 36 weeks in labour-delivery
complex."
om
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241. Least common presentation of twins ?

a) Both vertex
b) Both breech
c) Both transverse
d) First vertex and 2nd transverse
Correct Answer - C
Ans. C.Both transverse
Lie - Presentation in twin pregnancy:
The most common lie in the fetuses is longitudinal (90%).
om
The combination of presentation of fetuses are:

r.c
Both vertex (50%)

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First breech second vertex (10%)

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First vertex and second transverse (rare)

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First yertex and second breech (30o/o)

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Both breech (10%)

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Both transverse (rarest).

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242.
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Presenting part in transverse lie ?

a) Shoulder
b) Face
c) Vertex
d) Brow
Correct Answer - A
Ans. A. Shoulder
'When the long axis of the fetus lies perpendicular o the maternal
spine or centralised uterine axis, it is called transverse lie.
om
But more commonly, fetal axis lies oblique to the maternal spine & is
r.c
then called oblique lie. In either of the conditions shoulder usually

ke
presents over the cervical opening during labour & both are
an
collectively called shoulder presentations."

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243. Severely anaemic pregnant patient in

cardiac failure. Choice of transfusion?
a) Platelets
b) Packed cells
c) Whole blood
d) Exchange transfusion
Correct Answer - B
Ans. B. Packed cells
om
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244. Hydrops fetalis is due to ?

a) Rh mismatch
b) Hyperproteinemia
c) Placental hypoplasia
d) All of the above
Correct Answer - A
Ans. A. Rh mismatch om
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245. Caput succedaneum indicates that fetus

was alive till ?
a) Immediately after birth
b) Till 2-3 days after birth
c) 2-3 weeks after birth
d) 2-3 months after birth
Correct Answer - A
Ans. A. Immediately after birth
om
CaPut succedaneum
Formation of swelling due to stagnation of fluid in the layers of scalp
r.c
beneath the girdle of contact.

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Boggy diffuse swelling, not limited to midline.

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Disappears spontaneously within 24 hours.

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Usually occurs after rupture of membranes.

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246. Caput succedeum is said to occur in

baby?
a) Within 24 hrs
b) 2-3 days
c) 2-3 weeks
d) 2-3 months
Correct Answer - A
Ans. A. Within 24 hrs
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247. For uterine prolapse in pregnancy, Ring

pessary can be inserted upto ?
a) 12 weeks
b) 14 weeks
c) 16weeks
d) 18 weeks
Correct Answer - D
Ans. D. 18 weeks
om
Pessary treatment for ProlaPse
It does not cure the prolapse, only gives symptomatic relief by
r.c
stretching the hiatus genitalis, thus preventing the uterine & vaginal
ke
descent.
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Indications of PessarY
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EarlY Pregnancy - uPto 18 weeks

irs
PuerPerium
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Patients absolutely unfit for surgery

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Patients unwilling for operation

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While waiting for surgery

Additional benefits like improvement of urinary symptoms
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248. Not a method for delivery of after-coming

head of breech ?
a) Forceps method
b) Burns and Marshall method
c) Malar flexion and shoulder traction
d) Half hand method
Correct Answer - D
Ans. D. Half hand method
om
Methods of delivery of aftercoming head are
Burns - Marshall method
r.c
ForcePs delivery
ke
Malar flexion and shoulder traction (modified Mauriceau-Smellie-Veit

an
technique)
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249. Investigation of choice in post

menopausal bleeding?
a) PAP smear
b) Laproscopy
c) Fractional curettage
d) Ultrasound
Correct Answer - C
Ans., C. Fractional curettage
om
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250. Preferred IUD for menorrhagea ?

a) NOVA T
b) Cu IUD
c) Mirena
d) Gyne fix
Correct Answer - C
Ans. C. Mirena om
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251. Preferred treatment for menorrhagea in

reproductive age group?
a) NOVA T
b) Cu IUD
c) OCPs
d) Hysterectomy
Correct Answer - C
Ans. C. OCPs
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252. Drug not used commonly for

menorrhagea ?
a) Methergin
b) Clomiphene
c) GnRH
d) NSAIDS
Correct Answer - A
Ans. A. Methergin
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253. Drug causing abruption placenta ?

a) Methadone
b) Cocaine
c) Amphetamine
d) Fluoxetine
Correct Answer - B
Ans. B. Cocaine om
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254.
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Classical C section indicated in ?

a) CA Cervix
b) Central placenta praevia
c) Failed induction
d) Fetal distress
Correct Answer - A
Ans. A. CA Cervix om
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255. Definitive indication of LSCS ?

a) Mento ant
b) Contracted pelvis
c) Occipito posterior
d) Vertex
Correct Answer - B
Ans, B. Contracted pelvis om
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256. After delivery upto which week is known

as puerperium?
a) 2 weeks
b) 4 weeks
c) 6 weeks
d) 8 weeks
Correct Answer - C
Ans. C. 6 weeks
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Immediate puerperium: 24 h
Early puerperium: upto 1 week
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Remote puerperium: upto 6 weeks

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257. Which of these steps is followed first for

the management of shoulder dystocia
after McRoberts maneuver?
a) Sharp flexion of hip joints towards abdomen
b) Supra pubic pressure
c) 90 degree rotation of posterior shoulder
d) Emergency c-section
Correct Answer - B
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Ans. B.Supra pubic pressure

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Applying a gentle suprapubic pressure is the first step in

management of shoulder dystocia after McRoberts maneuver.
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Mnemonic “HELPERR” as a guide for treating shoulder

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dystocia:
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“H” stands for help

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“E” stands for evaluate for episiotomy.

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“L” stands for legs(pull your legs toward your stomach McRoberts
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maneuver)
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“P” stands for suprapubic pressure

“E” stands for enter maneuvers(internal rotation of baby’s shoulders)
“R” stands for remove the posterior arm from the birth canal.
“R” stands for roll the patient.
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258. Peripartum cardiomyopathy occurs at-

a) Within 7 days
b) Within 6 weeks
c) Within 24 months
d) Within 5 months
Correct Answer - D
Ans. D. Within 5 months
PPCM is a structural heart muscle disease that occurs in women
either at the end of pregnancy or up to five months after giving birth.
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Pearson’s diagnostic criteria for peripartum cardiomyopathy:

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Development of cardiac failure in the last month of pregnancy or

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within 5 months after delivery

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Absence of an identifiable cause for the cardiac failure

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Absence of recognizable heart disease prior to the last month of

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pregnancy, and
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Left ventricular systolic dysfunction demonstrated by classic

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echocardiographic criteria, such as depressed ejection fraction or

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fractional shortening along with a dilated left ventricle.

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259. Nerve mostly compressed in pregnancy

puerperium:
a) Radial nerve
b) Median nerve
c) Femoral nerve
d) Facial nerve
Correct Answer - C
Ans C. Femoral nerve
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The most common postpartum nerve injury is foot drop due to injury
to the peroneal nerve and injury to the lateral femoral cutaneous
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nerve.
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Obstetricians may consider frequent position changes in labor,

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avoidance of prolonged hip flexion, and shortening the pushing time

tR
by allowing for passive descent of the fetus before pushing begins

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as means of avoiding lateral femoral cutaneous nerve injury.

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260. In pregnancy which of the following level

is altered mostly:
a) Total T3
b) Free T3
c) Free T4
d) TSH
Correct Answer - A
Ans A. Total T3
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Total T3 levels are altered throughout pregnancy.
Hormones during pregnancy:
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Increased Decreased Unchanged

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Growth Hormone Luteinizing hormone ADH

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Follicle-stimulating Free
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hormone T3,Free T4
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Di-Hydro
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Prolactin
EpiAndroSterone
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Total T3, Total T4

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Aldosterone
Testosterone,Androstenodione
and cortisol
Insulin(due to insulin resistance)
Estrogen
Progesterone
Total T3 and total T4 increase due to stimulation of thyroid tissue by
hCG during the early period of gestation. But there is no change in
free T3 and T4 due to increase in TBG.
This leads to transient fall in TSH during an early weeks of gestation.
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The level of TSH reaches normal level during second and third
trimester.
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261. What is meant by Superfecundation?

a) Fertilization of two or more ova in one intercourse
b) Fertilization of two or more ova in different intercourses in same

menstrual cycle
c) Fertilization of ova and then it's division
d) Fertilization of second ovum first being implanted
Correct Answer - B
Ans. B. Fertilization of two or more ova in different intercourses
in same menstrual cycle
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Superfecundation is the fertilization of two or more ova from the

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same cycle by sperm from separate acts of sexual intercourse,

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which can lead to twin babies from two separate biological fathers.
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The term superfecundation is derived from fecund, meaning the

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ability to produce offspring.

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262. Acute fatty liver commonly seen in

pregnancy at-
a) 3rd trimester
b) 1st trimester
c) Immediate postpartum
d) Intrapartum
Correct Answer - A
Ans. A. 3rd trimester
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Acute fatty liver of pregnancy (AFLP) is a rare, potentially fatal
complication that occurs in the third trimester or early postpartum
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period.
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Acute fatty liver of pregnancy is more commonly associated with:

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Male fetus
tR
First pregnancy
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Maternal obesity
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It is due to defect in the long-chain-3-hydroxyacyl-CoA-

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dehydrogenase pathway.
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It is uncommon in subsequent pregnancies.
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263. Fetal heart starts contracting at-

a) 10-12 days
b) 10-12 weeks
c) 3-5 weeks
d) 3- 5 month
Correct Answer - C
Ans. C 3-5 weeks
The fetal heart starts contracting at approximately 23 days of
gestation.
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264. Which of the following is correct

regarding placenta?
a) Placental artery provides nutrients through umbilical cord to
baby
b) Placenta has Wharton's jelly
c) Placenta has 2 veins and 1 artery
d) Estrogen is secreted by placenta
Correct Answer - B
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Ans. B. Placenta has Wharton's jelly
The umbilical cord is a structure that provides vascular flow between
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the fetus and the placenta.

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It contains two arteries and one vein, which are surrounded and
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supported by gelatinous tissue known as Wharton's jelly.

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265.
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Anesthesia of choice for cesarean section in

severe pre-eclampsia :
a) Spinal
b) GA
c) Epidural
d) Spinal+epidural
Correct Answer - C
Ans. C. Epidural
om
Continuous Epidural Anesthesia is the first choice for patients with
preeclampsia during labour, Vaginal delivery and cesarean section.
r.c
Preeclampsia patients have a risk of severe airway edema , which

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makes intubation difficult

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Continuous Epidural Anesthesia can improve uteroplacental

tR
perfusion and also decrease catecholamine secretions.

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266. Which of the following is not a high-risk

pregnancy?
a) Previous history of manual removal of placenta
b) Anemia
c) Diabetes
d) Obesity
Correct Answer - A
Ans. A. Previous history of manual removal of placenta
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High Risk Pregnancy is seen in :
Cardiovascular and renal factors:
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Moderate to severe preeclampsia

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Chronic hypertension
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Severe heart failure (class II-IV, NYHA classification)

tR
Moderate to severe renal disorders

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Metabolic disorders:
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Obesity
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Insulin-dependent diabetes
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Previous endocrine ablation

Obstetric history:
Fetal exchange transfusion because of Rh incompatibility
Stillbirth
Late abortion (16–20 wk)
Post-term pregnancy (> 42 wk)
Preterm newborn (< 37 wk and < 2500 g)
Intrauterine growth restriction (weight < 10th percentile for estimated
gestational age)
Polyhydramnios
Multifetal pregnancy
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Previous brachial plexus injury

Abnormal fetal position
Other disorders:
Abnormal cervical cytologic findings
Sickle cell disease
Severe anemia
Thrombophilia
Autoimmune disorders
Anatomic abnormalities:
Uterine malformation
Insufficient (incompetent) cervix
Exposure to teratogens:
Group B streptococcal infections
Smoking > 10 cigarettes/day (associated with premature rupture of
membranes)
Current pregnancy complications:
Preterm labor at < 37 Wks
Preterm premature rupture of membranes
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Moderate to severe preeclampsia

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Polyhydramnios (hydramnios) or oligohydramnios

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Post-term (> 42 wk)

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Uterine rupture
tR
Placenta previa
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Abruptio placentae
Chorioamnionitis
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Prolapsed cord
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Fetal bradycardia for >30 min

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Fetal tachycardia for >30 min

Fetal weight < 2.5 kg
Fetal weight > 4 kg
Fetal acidosis pH ≤7
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267. Which of the following is not used in

preeclampsia?
a) Methyldopa
b) Atenolol
c) Labetalol
d) Hydralazine
Correct Answer - B
Ans. B. Atenolol
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Choice of anti-hypertensives in pregnancy
PIH / pre-eclampsia / severe pre-eclampsia : Labetalol
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Acute Hypertension/Hypertension crisis : IV labetalol > Nifedipine

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> Hydralazine
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Chronic Hypertension in pregnancy : Labetalol > Methyl dopa.

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268. Postmenopausal women 1st line of drug

for osteoporosis is-
a) OCP
b) Bisphosphonates
c) Raloxifene
d) Strontium
Correct Answer - B
om
Ans. is. B. Bisphosphonates

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First line of management of osteoporosis – Bisphosphonates

females.
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Alendronate, etidronate, pamidronate, and Ibandronate are

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bisphosphonates which inhibit bone resorption, and are very

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effective for both osteoporosis prevention and treatment.

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Uses:
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First line drugs for treating postmenopausal osteoporosis

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Paget’s disease
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Osteolytic bone metastasis.

Raloxifene: It is a selective estrogen receptor modulator which is
also useful in management of osteoporosis but it is a hormonal
preparation.
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269. A 36-week old pregnant lady with

previous twin delivery. What is the
Ovarian score?
a) G2P1
b) G2P2
c) G3P2
d) G3P3
Correct Answer - A
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ANS. A.G2P1
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Gravida includes all confirmed pregnancies. Each pregnancy is only

counted one time, even if the pregnancy was multiple gestations,
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such as twins or triplets

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Parity reflects the total number of births after 20 weeks, not the total
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number of infants born.

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Ref.OBS Dutta 8th ed Page no. 107

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270. DCDA twins, 38wks, first twin breech

mother has BP 140/96, 1+ proteinuria
what's the management
a) Immediate LSCS
b) Induction at 40 weeks
c) Immediate induction and delivery
d) Induction if signs of preeclampsia
Correct Answer - A
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ANS. A. Immediate LSCS

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CASE DISCUSSION:
The patient has mild preeclampsia with BP 140 / 96, so TOP is 37
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weeks.
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This patient is 38 weeks so immediate termination of pregnancy is

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required.
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The first twin is breech so the mode of delivery is LSCS hence the
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answer is A.
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INDICATIONS OF CESAREAN SECTION:

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The indications are broadly divided into:

Obstetric
Placenta previa
Preeclampsia
Previous cesarean section
Cord prolapse of the first baby
Abnormal uterine contractions
Contracted pelvis.
For twins:
Both the fetuses or even the first fetus with noncephalic (breech or
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transverse) presentation
Twins with complications: IUGR, conjoined twins
Monoamniotic twins
Monochorionic twins with TTTS
The collision of both the heads at brim preventing engagement of
either head.
Ref.OBS Dutta 8th ed Page no. 244
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271. A 32-year-old woman complains of

amenorrhea since the delivery of a baby
15 months previously, despite the fact
that she did not breastfeed her baby. The
delivery was complicated by excessive
hemorrhage that required a transfusion
of 2.5 liters of blood. She has also been
fatigued and has gained an additional
4.5Kg since the baby was born.
Laboratory data show the following:
Serum LH < 1 IU/L (normal, 4-24 IU/L)
Serum estradiol 5 pg/mL (normal, 20 -
100 pg/mL)
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Serum TSH 0.1 mU/L (normal, 0.5 - 5

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mU/L)
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Serum GH 3 ng/mL (normal, < 5 ng/mL)

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Serum ACTH 28 pg/mL (normal, 10 - 50

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pg/mL)
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Serum prolactin 2 ng/mL (normal,

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Injection of 500 μg of TRH failed to

produce the expected rise in both serum
TSH and prolactin. Which of the
following diagnoses most likely explains
the findings in this patient?
a) Hashimoto's thyroiditis
b) Isolated gonadotropin deficiency
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b) Isolated gonadotropin deficiency
c) Primary amenorrhea
d) Sheehan's syndrome
Correct Answer - D
Ans. D. Sheehan's syndrome
Sheehan's syndrome
It is hypopituitarism due to ischemic damage to the pituitary resulting
from excessive hemorrhage during parturition.
The pituitary is enlarged during pregnancy; it is more metabolically
active, and more susceptible to hypoxemia.
Furthermore, the blood vessels in the pituitary may be more
susceptible to vasospasm because of the high estrogen.
In about 30% of women who hemorrhage excessively during
om
parturition, some degree of hypopituitarism eventually becomes

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manifest.
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The symptoms depend on how much of the pituitary is damaged and

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what cell types are destroyed. The patient described above exhibited
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persistent amenorrhea after the delivery of her infant.

irs
This is due to the destruction of pituitary gonadotrophs and

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diminished secretion of gonadotropins (LH).

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There also appears to have been significant destruction of

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lactotrophs since TRH injection failed to induce an increase in

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prolactin.
Had the women attempted to breastfeed her infant, a failure to
lactate mostly likely would have occurred.
This case is also characterized by secondary hypothyroidism.
The low TSH and failure to respond to TRH injection are
confirmatory.
Corticotrophs appear to have been spared since plasma ACTH is
normal.
It is not clear whether somatotrophs were damaged.
Further testing would be needed to see if GH reserve is diminished.
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Ref. William Obs. ed. 24th page no.798, 1163

Dutta Gynaecology 6th ed. Page no. 465
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272. A 7 weeks pregnant lady has 1 accidental

exposure to x-ray. Which of the following
should be done?
a) Continue pregnancy
b) Terminate pregnancy
c) Chromosome analysis
d) Pre invasive diagnostic testing
Correct Answer - A
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Ans. A. Continue pregnancy

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Exposure to X-ray has a very low range of rad so in given case

scenario Pregnancy will be continued.
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Exposure >15 rad during the second and third trimester or >5 rad in
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the first trimester needs patient counseling. Elective termination of

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pregnancy may be considered.

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Ref. OBS Dutta 8th edition Page no. 740

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William’s Obs 24th edition Page no. 931 Table no 46-5

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273. In Modern obstetrics, for sensitized Rh-

negative mother what should be done to
evaluate the condition of the mother?
a) MCA doppler peak systolic volume
b) Fetal blood
c) Amniocentesis
d) Biophysical profile
Correct Answer - A
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Ans. A. MCA doppler peak systolic volume

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Doppler ultrasound: Serial Doppler study of the middle cerebral

artery (MCA)-peak systolic velocity (PSV) is the mainstay to assess
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fetal anemia. A value >1.5 multiples of the median (MOMs) for the
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corresponding gestational age, predicts moderate to severe fetal

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anemia.
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This value (between 24 weeks and 35 weeks of gestation), is an

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indication for cordocentesis and fetal transfusion

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Most centers have replaced serial amniocentesis with serial MCA

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Doppler studies.
Ref. OBstetrics Dutta ed. 8th pg. 391
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274. A patient delivered at home with a

complete perineal tear came to the
hospital after 2 weeks. What
management will you prefer?
a) Immediate repair
b) Repair 3 weeks post-delivery
c) Repair 6 weeks post-delivery
d) Repair 3 months post-delivery

om
Correct Answer - D
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Ans. D. Repair 3 months post-delivery

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The recent tears should be repaired immediately following the

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delivery of the placenta. This reduces the chance of infection and

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minimizes blood loss.

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In cases of delay beyond 24 hours, the repair is to be withheld.

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Antibiotics should be started to prevent infection.

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The complete tear should be repaired after 3 months if delayed

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beyond 24 hours.
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In case of any doubt to the grade 3rd-degree tear, it is advisable to

classify to a higher degree rather than a lower degree.
Ref.Obs Dutta 24th edition Page no. 490
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275. All are used for postcoital contraception

except-
a) CuT
b) Ru 486
c) High dose estrogen
d) Danazol
Correct Answer - D
Ans. D. Danazol
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EMERGENCY CONTRACEPTIVES:
Drug Dose PREGNANCY
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RATE
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Levonorgestrel 0.75 mg stat and 0–1

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after 12 hours
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Ethinyl estradiol 50 µg + 2 tab stat and 2 after 0–2

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norgestrel 0.25 mg 12 hours

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Ethinyl estradiol 2.5 mg Bd × 5 days 0–0.6

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Mifepristone 100 mg single dose 0–0.6

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Copper Iuds (Gold standard) Insertion within 5 0–0.1

days
(RU 486Mifepristone) 30 mg PO 0–1
(ulipristal acetate)
Ref:DUTTA GYNAECOLOGY ED. 6TH PAGE NO. 492
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276. 33 yr old female with heavy menstrual

bleeding for 6 months comes to the
gynaecology OPD. On examination, no
abnormality was seen. USG also
appeared normal. The patient was tried
to be managed on non-hormonal
treatment but it failed. What will be the
next management step?
a) Hormonal therapy
b) Endometrial sampling
c) Hysterectomy
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d) Hysterectomy
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Correct Answer - B
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Ans. B.Endometrial sampling

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Before starting Hormonal therapy endometrial sampling is done as if

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hormonal therapy precedes sampling the sampling results will be

altered.
As already mentioned in question the USG and clinical examination
show no abnormality hence the diagnosis can’t be made on that so
for diagnosis we need to do endometrial sampling and see the
hormonal pattern. Then we can proceed with hormonal therapy.
Ref. Dutta Gynaecology ed. 6th page no. 120
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1. The thickness of endometrium at the time

"After ovulation, the endometrium now demonstrates a combined

reaction to estrogen and progesterone activity. Most impressive is

that total endometrial height is fixed at roughly its preovulatory

extent (5 -6 mm) despite continued availability of estrogen."

Reading the above text it is clear that endometrium is - 5 - 6 mm

2. Zygote with zona pellucida reaches uterine

3. Ligamentum terea is formed after ':

b) Obliteration of the ductus venous

c) Obliteration of the ductus arteriosus

d) Obliteration of the hypogastric artery

4. The role of human placental lactogen is :

b) Fetal breast development

maternal circulation, breakdown of fats and proteins and transport of

fatty acids and amino acids from maternal to feta circulation.

b) Potent angiogenic, helps develop fetal vasculature.

c) Promotes growth of breast for lactation.

5. Commonest cause for puerperal sepsis is :

6. The best method for inducing mid trimester

i) Prostaglandins : misoprostol (PGE 1) with or without Mife

pristone, gemeprost (PGE1), dinoprostone (PGE2), carboprost

7. Most common site of Implantation of tubal

8. During which gestational age is peak serum HCG levels attained ?

day (9 to 10 weeks) LMP.

constant until birth.

9. The uterine artery is a branch of which of the following?

b) Internal iliac artery

c) Internal pudendal artery

Isthmic rupture usually occurs at 6-8 weeks, the ampullary one at 8-

12 weeks and the interstitial one at about 4 months.

Ref: Textbook of Obstetrics by DC Dutta, 6th edition, Page 181.

extended head or submento vertical 11.5cm in partially extended head.

Ref: Textbook of Obstetrics By D.C Dutta, 6th edn, page 392-3

12. Which of the following statements regarding fetal circulation is correct?

b) PO2 of fetal blood leaving the placenta is slightly greater than

c) The presence of fetal hemoglobin shifts the oxyhemoglobin

than the maternal mixed venous blood.

increase the transport of oxygen to fetal tissues.

A number of significant differences in circulating patterns are present in the fetus.

13. Most common cause of secondary PPH is

Causes of late PPH :

Retained bits of cotyledon or membranes (M.C.)

Infection and separation of slough over a deep cervico - vaginal

Endometritis and subinvolution of the placental site.

14. The major contribution of the amniotic

c) Fetal lung fluid

After about 20 weeks, fetal urine makes up most of the fluid.

Incidence of scar rupture in a subsequent

it does occur, maternal death is much less and the perinatal

16. The characteristics of caput succedaneum

b) Crosses the suture line

c) It does not disappear within 2-3 days

d) It is a diffuse edematous swelling of the soft tis​sues of the scalp

Soften gradually and disappear within 2-3 days

Diffuse crosses suture line ill defined margin.

Not associated with prolonged jaundice

17. Hydrocephalus is best detected

"The prenatal diagnosis of hydrocephalus is usually made by

d) It is a diffuse edematous swelling of the soft tissues of the scalp