ASSISTANT PROFESSOR IN OBSTETRICS AND GYNAECOLOGY -MEDICAL EDUCATION DEPARTMENT (CAT.NO.010/2020)

PROVISIONAL ANSWER KEY
Question Paper Code: 7/2021/OL
Category Code: 010/2020
Exam: Assistant Professor in Obstetrics and Gynaecology
Date of Test 15-03-2021
Department Medical Education Services
Alphacode A
Question1:-All are TRUE regarding Fetomaternal unit in pregnancy EXCEPT
A:-Progesterone production by the placenta is largely independent of the quantity of precursor available, the utero-placental perfusion and fetal well-being
B:-There is a 17 alpha hydroxylase enzyme block in the fetus and placenta has very little 3 beta hydroxyl steroid dehydrogenase activity
C:-Cholesterol and pregnenolone are obtained mainly from the maternal bloodstream for placental progesterone synthesis
D:-In human syncytiotrophoblast, estradiol increases progesterone production by means of an increase in LDL uptake
Correct Answer:- Option-B
Question2:-All are TRUE statements about Corpus luteum of Pregnancy EXCEPT
A:-Progesterone is largely produced by the corpus luteum until about 10 weeks of gestation
B:-Pulsatile luteinizing hormone (LH) and human chorionic gonadotropin (hCG) from the implanting pregnancy stimulate progesterone production by the corpus luteum
C:-In the luteal phase of conception cycles, progesterone concentrations increase from about 1-2 mg/mL on the day of the LH surge to a plateau of approximately 10-35 mg/mL
D:-The transitional luteo-placental shift takes place between the 10�ℎ
week and 12�ℎ
week
Correct Answer:- Option-D
Question3:-The FALSE statement regarding the glycoprotein hormone Human Chorionic Gonadotropin (HCG) is
A:-A maximal level of about 100,000 IU/L in the maternal circulation is reached at 8-10 weeks of gestation
B:-Long half-life of hCG (48 hours) is due mainly to the greater amino acid content of beta subunit
C:-Hyperglycosylated hCG is the major circulating form of hCG regulating trophoblastic invasion in the first weeks of normal pregnancies
D:-β-hCG can be detected in maternal blood about the eighth day after ovulation or one day after implantation
Correct Answer:- Option-B
Question4:-Find out the FALSE statement regarding human parturition
A:-The initiating step in the sequence of events leading to parturition could bean increase in fetal ACTH and cortisol secretion and an increase in placental CRH
B:-There is a definite decline in peripheral blood levels of progesterone prior to parturition and not just a functional withdrawal
C:-An increase in estrogen levels in maternal blood begins at 34-35 weeks
D:-The activity of 15-hydroxyprostaglandin dehydrogenase decreases in the myometrium and the chorion during labor and causes increase in prostaglandins associated with
parturition
Correct Answer:- Option-B
Question5:-All the following statements about fetal lung surfactant are TRUE EXCEPT
A:-Phosphatidylcholine (lecithin) and phosphatidylglycerol (PG) are present in only small concentrations until the last 5 weeks of pregnancy
B:-At 20-22 weeks of pregnancy, a less stable and less active lecithin, palmitoyl-myristoyl lecithin, is formed
C:-At about the 30�ℎ
week of gestation, there is a sudden surge of dipalmitoyl lecithin, the major surfactant lecithin
D:-The Sphingomyelin concentration of amniotic fluid changes relatively little throughout pregnancy and prior to 34 weeks, the Lecithin : Sphingomyelin L/S ratio is approximately
1 : 1
Correct Answer:- Option-C
Question6:-All the following are TRUE statement about gonadal differentiation EXCEPT
A:-It now appears that both testis and ovary differentiation require dominantly acting genes
B:-SRY activation of SOX 9 may be all that is necessary to activate other genes important to testis development
C:-WNT4 and R-Spondin 1(RSPO1) genes team to promote ovary development via repression of SOX9
D:-Ovarian differentiation is considered the “default” pathway of sexdetermination the automatic result in the absence of a testis-determining factor
Correct Answer:- Option-D
Question7:-All are TRUE statements about Complete Androgen Insensitivity EXCEPT
A:-One in three phenotypic sisters of an affected individual may have an XY karyotype but 40% may not have a family history
B:-The normal testes produce normal amounts of AMH and testosterone and absent spermatogenesis, serum LH levels are increased and the serum FSH usually is in the normal
range
C:-They present with primary amenorrhea, normal breast development, absent or scant pubic and axillary hair, a short vagina and an absent cervix and uterus
D:-Gonadectomy generally is best done before puberty because the overall risk for tumor development is 30%
Correct Answer:- Option-D
Question8:-The FALSE statement regarding Congenital Adrenal Hyperplasia is
A:-An females, the classic forms of CAH (with and without salt wasting) are characterized by genital ambiguity and is most commonly due to 21-hydroxylase deficiency
B:-Two-thirds of patients with 11β-hydroxylase deficiency exhibit hypotension and hypokalemia
C:-Females with the non-classical “late-onset” form of 21-hydroxlyased deficiency have normal external genitalia and present later, during early adolescence with precocious
puberty or other signs of hyperandrogenism such as hirsutism
D:-Diagnosis of 21-hydroxylase deficiency is based on a high serum concentration of 17-OH Progesterone
Correct Answer:- Option-B
Question9:-The FALSE statement about Puberty in humans is
A:-“diphasic” pattern of gonadotropin secretion from infancy to puberty results primarily from a high sensitivity to low levels of gonadal steroid feedback
B:-central GABA signaling is one of the factors that restrains GnRH neuronal activity during childhood
C:-glutamate signaling may play a role in the resurgence of pulsatile GnRH secretion at the onset of puberty
D:-hypothalamic kisspeptin-GPR54 signaling is a key component of the neurobiologic mechanism that triggers the onset of puberty
Correct Answer:- Option-A
Question10:-All are TRUE regarding premature ovarian Insufficiency (POI) EXCEPT
A:-In all patients under age 30 with a diagnosis of POI, a karyotype should be obtained
B:-Women with POI should be offered testing for FMR1 premutations
C:-Women with POI should be screened for antiadrenal antibodies and for antithyroid antibodies
D:-Likelihood of achieving pregnancy after diagnosis of POI is about 60-80% and donor eggs are rarely required for IVF
Correct Answer:- Option-D
Question11:-The FALSE statement regarding PolyCystic Ovarian Syndrome (PCOS) is
A:-AMH production is increased severalfold in anovulatory PCOS
B:-Those with PCOS generally exhibit altered GnRH pulse frequency, increased serum LH concentrations and low-normal FSH levels
C:-Insulin acts synergistically with LH to perpetuate ovarian androgen production and also inhibits hepatic SHBG production
D:-Insulin resistance due to obesity also causes increased leptinsignalling and increased adiponectin levels, there by decreasing fatty acid oxidation and promoting lipotoxicity
Correct Answer:- Option-D
Question12:-Identify the FALSE statement about Metformin
A:-Metformin increases insulin sensitivity up to 20% and decreases fasting glucose by about 5%
B:-Metformin decreases weight and BMI by 3-5%
C:-Metformin has no effect on lipolysis and HDL cholesterol
D:-Metformin improves the chronic inflammatory state in women with hyperinsulinemia
Correct Answer:- Option-C
Question13:-All statements regarding Familial cancers are TRUE EXCEPT
A:-about 15-20% of women who develop ovarian cancer have mutations in BRCA1 gene
B:-Prophylacticsalpingo-oophorectomy reduces the risk of ovarian cancer by about 90% and the risk of breast cancer by about 50%
C:-Risk-reducing salpingo-oophorectomy is recommended at age 35 or when childbearing is complete for patients carrying BRCA1 mutations and by age 40 in BRCA2 carriers
D:-The use of combined oral contraceptives is likely to reduce the risk of ovarian cancer, but the effect on breast cancer risk is uncertain
Correct Answer:- Option-A
Question14:-All are TRUE about Tamoxifen EXCEPT
A:-Tamoxifen is selective estrogen receptor modulator, having both estrogen receptorantagonist and agonist properties, depending on the tissue
B:-The incidence of endometrial cancer quadrupled with 5 years of tamoxifen treatment
C:-Levonorgestrel intrauterine device (IUD) is not effective to protect the endometrium against hyperplasia and polyps in women using tamoxifen
D:-Tamoxifen is associated with an ultrasonographic image that is characterized by sonolucent changes that are subepithelial in the presence of atrophic epithelium
Correct Answer:- Option-C
Question15:-Identify the FALSE statement about Endometrial Hyperplasia
A:-Lesions without atypia basically represent only exaggerated forms of persistent proliferative endometrium and are associated with little risk (1-3%) for progression to
adenocarcinoma
B:-Atypical endometrial hyperplasia does not often spontaneously regress and has significant risk (10-30%) of progression to adenocarcinoma if left untreated
C:-There is significant risk (upto 40%) of an unrecognized adenocarcinoma in endometrial hyperplasia with atypia
D:-Biopsy is not indicated when the clinical history suggests long-term unopposed estrogen exposure but the endometrial thickness is 5-12 mm
Correct Answer:- Option-D
Question16:-STRAW stage-3a is characterized by
A:-menstrual cycles are relatively unchanged, the serum levels of FSH are low, AMH and inhibin B are low
B:-menstrual cycles become shorter, FSH increases, while AMH, AFC and inhibin B declines
C:-periods of amenorrhea lasting greater than or equal to 60 days, FSH level in menopausal range, vasomotor symptoms such as hot flushes
D:-undetectable AMH, Inhibin and occasional antral follicle
Correct Answer:- Option-B
Question17:-The FALSE statement regarding Menopausal Hormone Therapy (MHT/HRT) is
A:-Continuous, combined estrogen-progestin regimens of HRT has more risk for endometrial cancer than long-term sequential regimens
B:-Ospemifene is given orally for the treatment of vulvar and vaginal atrophy
C:-Bazedoxifene combined with conjugated estrogens is effective for hot flushes and vaginal atrophy, prevents bone loss and does not stimulate the endometrium or cause breast
tenderness
D:-The use of tibolone in women with a history of breast cancer remains relatively contraindicated
Correct Answer:- Option-A
Question18:-All the statements about Emergency Contraception are TRUE EXCEPT
A:-Copper IUD can be used anytime during the preovulatory phase of the menstrual cycle and upto 8 days after ovulation
B:-Ulipristal acetate is slightly more effective than the single 1.5-mg dose of levonorgestrel when used within 120 hours
C:-Mifepristone prevents about 80-85% of expected pregnancies and has the same efficacy and side effects as levonorgestrel method
D:-Treatment with Levonorgestrel acts primarily by preventing or delaying ovulation and by preventing fertilization
Correct Answer:- Option-A
Question19:-The FALSE statement about etonogestrel Implant (Nexplanon) is
A:-Inhibits ovulation by preventing LH surge and failure rate is 0.01%
B:-Implants have an immediate contraceptive effect when inserted within the first 7 days of a menstrual cycle
C:-Implants should not be inserted immediate postpartum
D:-It is absolutely contraindicated in women with active thromboembolic disease or known breast cancer
Correct Answer:- Option-C
Question20:-All the statements about reproductive ageing are TRUE EXCEPT
A:-Age related Oocyte aneuploidy results primarily from premature separation of sister chromatids during meiosis I or from whole chromosome nondisjunction during meiosis II
B:-Miscarriage riks and the prevalence of aneuploidy oocytes are relatively low and change little until approximately age 35
C:-Live birth rates in donor egg IVF cycles relate to the age of the donor, not the age of the recipient
D:-Aging itself is thought to be a significant factor influencing uterine endometrial response to steroids and receptivity
Correct Answer:- Option-D
Question21:-Identify the FALSE statement regarding Test for Ovarian Reserve
A:-Total number of antral follicles measuring 2-10 mm in both ovaries is proportional to the number of primordial follicles remaining
B:-Small antral follicles (2-6 mm) are likely the primary source of AMH because they contain larger numbers of granulosa cells and a more developed microvasculature
C:-Recent studies suggest AMH levels decrease with the use of oral contraceptives and GnRH agonists
D:-A single elevated Day -3 FSH concentration (>10 IU/L) has high specificity for predicting poor response to stimulation or failure to achieve pregnancy
Correct Answer:- Option-D
Question22:-Find the FALSE statement
A:-The prevalence of uterine anomalies in infertile women and fertile women with normal reproductive outcomes is similar, approximately 2-4%
B:-Submucousmyomas reduce IVF success rates by approximately 70% and intramural myomas by approximately 20-40%
C:-Hysteroscopic polypectomy may improve reproductive performance in infertile women
D:-Conception and term delivery rates after successful hysteroscopiclysis of intrauterine adhesions are > 80%
Correct Answer:- Option-D
Question23:-The FALSE statement regarding Male infertility is
A:-2-5% of men with severe oligospermia and 8% of men with azoospermia may have Y chromosome microdeletions
B:-Hyperprolactinemia and treatment with GnRH analogs or androgens can cause hypogonadotropic hypogonadism in males
C:-Men with idiopathic infertility have significantly lesser CAG trinucleotide repeat lengths in androgen receptor gene
D:-Disorders of estrogen synthesis or action may be associated with infertility in men
Correct Answer:- Option-C
Question24:-Risk factors for Ovarian Hyperstimulation Syndrome (OHSS) include all EXCEPT
A:-Young age
B:-Higher BMI
C:-Higher AMH and AFC
D:-Higher serum Oestradiol
Correct Answer:- Option-B
Question25:-Preimplantation Genetic Testing (PGT) – Find the FALSE statement
A:-Can be used to detect numerical chromosomal aneuploidies and monogenic disorders but not structural rearrangements
B:-Chromosomal composition of the oocyte may be inferred from that of the extruded polar bodies
C:-One or two blastomeres may be removed from cleavage stage embryos
D:-Biopsy of the trophectoderm can be performed at the blastocyst stage and has become the most commonly used technique
Correct Answer:- Option-A
Question26:-Medical management of endometriosis – Find the FALSE statement
A:-Approximately 85% of women with endometriosis and pelvic pain who are treated with GnRH agonists experience relief of their pain
B:-Dienogest is effective in improving endometriosis-associated pain and may even help overcome progesterone resistance by increasing the number of progesterone receptors
C:-Estrogen-progestin contraceptives is cytoreductive and halts progression of endometriosis in upto 90% of affected women when taken continuously
D:-The levonorgestrel-releasing intrauterine device is of value in women with deep infiltrating rectovaginal endometriosis in reducing pain and dysmenorrhea recurrence following
surgical therapy
Correct Answer:- Option-C
Question27:-Find the INCORRECT statement regarding Ectopic pregnancy
A:-the overall risk of recurrence is approximately 10% for women with one previous ectopic pregnancy and at least 25% for women having two or more
B:-estrogen-progestin contraceptives and vasectomy are associated with the lowest absolute incidence of ectopic pregnancy (0.005 ectopic pregnancies/1,000 women years)
C:-if pregnancy does occur with an IUD in situ, the risk for ectopic pregnancy is as high as 80%
D:-approximately one-third of all pregnancies resulting from sterilization failure are ectopic
Correct Answer:- Option-C
Question28:-Medical Management of Ectopic pregancy-Find INCORRECT statement
A:-In 85% cases, serum β-hCG concentrations rise somewhat between days 1 and 4 and does not necessarily indicate failed treatment
B:-Medical treatment is not contraindicated for ectopic pregnancies with serum β-hCG concentrations greater than 5,000 IU/L or presence of embryonic heart activity, but the
likelihood of treatment failure and the risk of tubal rupture are increased substantially
C:-Anti D immunoglobulin need be administered only tononsensitized Rh-negative women with ectopic pregnancy undergoing surgical management
D:-Free peritoneal fluid may be observed in almost 40% of women with early unruptured ectopic pregnancies and that the presence or absence of cul-de-sac fluid does not
accurately predict the success or failure of medical treatment
Correct Answer:- Option-C
Question29:-Fetoplacental blood volume at term is approximately
A:-125 ml/kg of fetal weight
B:-80 ml/kg of fetal weight
C:-45 ml/kg of fetal weight
D:-240 ml/kg of fetal weight
Correct Answer:- Option-A
Question30:-Find the INCORRECT statement regarding international guidelines on vaccination in pregnancy
A:-A dose of tetanus-diphtheria-acellular pertussis (Tdap) is ideally given to gravidas between 27 and 36 weeks’ gestation
B:-All women who will be pregnant during influenza season should be offered vaccination, regardless of gestational age
C:-Avoid becoming pregnant for atleast one month after MMR vaccination
D:-HPV vaccination may be administered to high risk pregnant women after the first trimester of pregnancy
Correct Answer:- Option-D
Question31:-The FALSE statement regarding fetal biometry by USS is
A:-Until 14 weeks’ gestation, the Crown-Rump Length (CRL) is accurate to within 5 to 7 days
B:-The biparietal diameter (BPD) most accurately reflects gestational age, with a variation of 7 to 10 days in the second trimester
C:-If the head shape is flattened-dolichocephaly or rounded brachycephaly, the Head Circumference (HC) is more reliable than the BPD
D:-To measure the AC, a circle is placed outside the fetal skin in a transverse image that contains the stomach, the kidneys and the confluence of the umbilical vein with the portal
sinus
Correct Answer:- Option-D
Question32:-All the following are indications for fetal ECHO EXCEPT
A:-thick nuchal translucency
B:-monochorionic twin gestation
C:-maternal anti cardiolipin antibodies
D:-maternal pregestational diabetes orphenylketonuria
Correct Answer:- Option-C
Question33:-Fetal renal pelviectasis – Find the CORRECT statement
A:-is present in 20 to 30 percent of fetuses
B:-in 30 percent of cases, it is transient or physiological
C:-the pelvis is typically considered dilated if it exceeds 4 mm in the second trimester or 7 mm at approximately 32 weeks’ gestation
D:-mild pyelectasis in the second trimester is not considered a soft marker for down syndrome
Correct Answer:- Option-C
Question34:-All the statements about Hydramnios (Polyhydramnios) are TRUE EXCEPT
A:-it is diagnosed when AFI exceeds 24 and complicates 1 to 2 percent of singleton pregnancies
B:-underlying causes of hydramnios include fetal anomalies-in approximately 15 percent and diabetes in 15 to 20 percent
C:-the degree of hydramnios correlates with the likelihood of an anomalous infant
D:-idiopathic hydramnios accounts for upto 30 percent of cases of hydramnios
Correct Answer:- Option-D
Question35:-Find the FALSE statement regarding teratogens in pregnancy
A:-less than 1 percent of all birth defects are caused by medications
B:-80 percent of birth defects do not have an obvious etiology and of those withan identified cause, nearly 95 percent of cases have chromosomal or genetic origins
C:-mono therapy with Levitracetam is associated with a 8-percent major malformation rate, which is slightly higher than that for the general population
D:-sulfonamides and nitrofurantoin are appropriate for use in pregnancy only if suitable alternatives are lacking
Correct Answer:- Option-C
Question36:-All are TRUE regarding cell free fetal DNA EXCEPT
A:-Reliably detected in maternal blood after 9 to 10 weeks’ gestation
B:-The proportion of cell-free DNA that is placental is called the fetal fraction and it composes approximately 50 percent of the total circulating cell-free DNA in maternal plasma
C:-The specificity to detect down syndrome, trisomy 18 and trisomy 13 is over 99 percent
D:-Real-time quantitative polymerase chain reaction (PCR) may be used for Rh genotyping, detection of paternally inherited single-gene disorders or fetal sex determination
Correct Answer:- Option-B
Question37:-All are TRUE regarding Prenatal Diagnosis EXCEPT
A:-Biopsy of chorionic villi is typically performed between 10 and 13 weeks’ gestation
B:-Transabdominal amniocentesis is generally done between 11 and 14 weeks
C:-FISH studies are usually completed within 24 to 48 hours
D:-Chromosomal MicroArray can often be performed directly on uncultured amniocytes with a turn around time of only 3 to 5 days
Correct Answer:- Option-B
Question38:-All are TRUE regarding Anti D immunoglobulin EXCEPT
A:-300 mcg dose is given for each 15 mL of fetal red cells or 30 mL of fetal whole blood to be neutralized
B:-Anti-D immune globulin may produce a weakly positive-1 : 1 to 1 : 4-indirect coombs titer in the mother
C:-Routine postpartum administration of anti-D immune globulin to at-risk pregnancies within 72 hours of delivery lowers the alloimmunization rate by 50 percent
D:-Antepartum anti-D immune globulin at 28 weeks’ gestation reduces the third-trimester alloimmunization rate from approximately 2 percent to 0.1 percent
Correct Answer:- Option-C
Question39:-All are TRUE regarding Non-Stress Test NST EXCEPT
A:-Before 32 weeks, normal accelerations are defined as having an acme that is 10 bpm or more above baseline for 10 seconds or longer
B:-Beat-to-beat variability is under the control of the autonomic nervous system
C:-Loss of reactivity is most commonly associated with fetal hypoxia
D:-Abnormal non-stress test is inadequate to preclude any acuteasphyxial event happening in a 7 day interval
Correct Answer:- Option-C
Question40:-All are TRUE regarding miscarriage EXCEPT
A:-balanced structural chromosomal rearrangements may originate from either parent and are found in 2 to 4 percent of couples with recurrent pregnancy loss
B:-the incidence of euploid abortion rises dramatically after maternal age exceeds 35 years
C:-a threshold CRL of 5 mm with absent cardiac activity is used to diagnose non-viability or embryonic demise
D:-absence of an embryo in a sac with a mean sac diameter (MSD) 25 mm signifies an embryonic pregnancy
Correct Answer:- Option-C
Question41:-In three tier system of CTG interpretation, category III abnormal CTG is all EXCEPT
A:-Absent baseline FHR variability and recurrent late deceleration
B:-Absent baseline FHR variability and recurrent variable deceleration
C:-Absent baseline FHR variability and bradycardia
D:-Prolonged deceleration > 2 min but < 10 min Correct Answer:- Option-D Question42:-Absolute contraindications to neuraxial analgesia in labour include all EXCEPT A:-Maternal coagulopathy B:-Thrombocytopenia C:-Prophylactic low-molecular-weight heparin within 12 hours D:-Refractory maternal hypertension Correct Answer:- Option-D Question43:-Proven contraindications for the use of PGE2 for induction of labour include all EXCEPT A:-suspicion of fetal compromise B:-bronchial asthma C:-unexplained vaginal bleeding D:-cephalopelvic disproportion Correct Answer:- Option-B Question44:-McRobert's maneuver for relieving shoulder dystocia acts by all the following EXCEPT A:-straightening of the sacrum relative to the lumbar vertebrae B:-rotation of the symphysis pubis toward the maternal head C:-decrease in the angle of pelvic inclination D:-increase in overall pelvic dimensions Correct Answer:- Option-D Question45:-All the following statements are TRUE EXCEPT A:-Case-control studies are most feasible for examining the association between a relatively common exposure and a relatively rare disease B:-Strengths of cohort studies include the ability to obtain attributable and relative risks (RRs) because the occurrence of the outcome is being compared in two groups C:-Phase 3 clinical trials determine the efficacy of treatment for the intended population, compared with other available treatments, assess adverse events and side effects D:-The negative predictive value (NPV) and positive predictive value (PPV) of a test does not vary with the baseline characteristics of population or prevalence of a disease Correct Answer:- Option-D Question46:-The following structures may be injured during sacrospinous ligament fixation EXCEPT A:-Pudendal nerve B:-Superior gluteal artery C:-Inferior gluteal artery D:-Internal pudendal vessels Correct Answer:- Option-B Question47:-All the following statements about ureteric injury are TRUE EXCEPT A:-75% of all iatrogenic injuries to the ureter result from gynecologic procedures B:-Laparoscopic hysterectomies have the least rate of ureteral injuries and vaginal hysterectomies the highest C:-Ninety-one percent of injuries occur at the level of the pelvicureter and only 2% and 7% occur at the upper and middle ureteral thirds D:-Careful identification of the ureter before securing the infundibulopelvic ligament and uterine artery is the best protection against ureteric injury during hysterectomy Correct Answer:- Option-B Question48:-All are TRUE regarding Dermoid cysts of ovary EXCEPT A:-Malignant transformation occurs in less than 2% of dermoid cysts in women of all ages B:-Upto 25% of dermoids occur in postmenopausal women C:-The risk of torsion with dermoid cysts is approximately 50% D:-They are bilateral in approximately 10% of cases Correct Answer:- Option-C Question49:-All are TRUE regarding Endometrial Intraepithelial Neoplasia (EIN) EXCEPT A:-Approximately 40% to 50% of women with atypical hyperplasia or EIN have concurrent carcinoma B:-The risk of progression of hyperplasia without atypia to cancer is low but is approximately 30% among those with atypical hyperplasia C:-Infertile women with EIN treated with high dose progestins should have an endometrial biopsy every 3 months D:-For women with EIN treated with progestins, recurrence risks approach 10% Correct Answer:- Option-D Question50:-According to the FIGO fibroid classification system type 3 is A:-50% or more of the fibroid diameter within the myometrium B:-Intramural and entirely within the myometrium, without extension to either the endometrial surface or to the serosa C:-Abuts the endometrium without any intracavitary component D:-Located in cervix or broad ligament Correct Answer:- Option-C Question51:-All are TRUE about atypical leiomyomas EXCEPT A:-Mitotically active leiomyoma is defined by the presence of 5 to 10 mitoses/10 high-power fields and may be found in pregnancy and OCP users B:-Cellular leiomyomas exhibiting chromosome 1p deletions, may be clinically more aggressive C:-STUMP shows atypical histologic features that range between leiomyoma and LMS but the mitotic count is less than 10/10 hpf D:-STUMP mostly those that are p53 and p16 positive, have been found to exhibit malignant potential to develop a low-grade LMS Correct Answer:- Option-A Question52:-Contraindications to Uterine Artery Embolisation (UAE) include all EXCEPT A:-desirous of future fertility B:-impaired renal dysfunction C:-diminished immune status D:-willingness for hysterectomy Correct Answer:- Option-D Question53:-The pharmacologic treatments for vulvodynia can include topical lidocaine 5% with any of the following EXCEPT A:-oral gabapentine and steroids B:-botulinum toxin injections C:-combined oestrogen and progesterone pills D:-menopausal hormone therapy Correct Answer:- Option-C Question54:-Find the INCORRECT statement about Chronic Pelvic Pain (CPP) A:-There appears to be no relationship between the incidence and severity of pain or the stage of the endometriotic lesions B:-The specific location and density of pelvic adhesions correlates consistently with the presence of pain symptoms C:-Endometriosis can be demonstrated in 15% to 40% of patients undergoing laparoscopy for CPP D:-The accuracy of ultrasound in detecting ovarian remnant syndrome can be improved by treating the patient with a 5- to 10-day course of clomiphene citrate Correct Answer:- Option-B Question55:-Find the FALSE statement regarding elagolix A:-used to suppress the estrogen production to a level that is adequate for symptom relief but minimizes hypoestrogenic effects B:-cannot produce a dose-dependent suppression of pituitary function and ovarian hormones like GnRH agonists C:-improves dysmenorrhea and nonmenstrual pelvic pain during a 6-month period in women with endometriosis-associated pain D:-orally active GnRH antagonist with no flare effect Correct Answer:- Option-B Question56:-The FALSE statement regarding trichomonial vaginitis is A:-Increased risk of PPROM and PTL in pregnant women and higher post hysterectomy cuff infection B:-Less than 10% of men contract the disease after a single exposure to an infected woman C:-T. vaginalis infection is associated with a two to three fold increased risk for HIV acquisition D:-Clue cells and Whiff test may be positive in TV Correct Answer:- Option-B Question57:-Find the FALSE statement regarding cervicitis A:-The microbial etiology of endocervicitis is unknown in about 50% of cases in which neither gonococci nor chlamydia is detected B:-Mycoplasma genitaliem, can be detected in 10% to 30% of women with clinical cervicitis C:-Nucleic acid amplification tests (NAAT) for gonorrhea and chlamydia, is not mandatory in all cases D:-Cervicitis is commonly associated with BV, which if not treated concurrently, leads to significant persistence Correct Answer:- Option-C Question58:-All the statements regarding PID are TRUE EXCEPT A:-About 75% of women with tubo-ovarian abscess do not respond to antimicrobial therapy alone and need drainage B:-No definite symptoms are defined to diagnose PID C:-Evaluation of both vaginal and endocervical secretions is a crucial part of the workup of a patient with PID D:-Additional criteria to increase the specificity of the diagnosis include endometrial biopsy, CRP and positive test for gonorrhea or chlamydia and laparoscopy Correct Answer:- Option-A Question59:-Regarding genital ulcers find the TRUE statement A:-The ulcer of syphilis has irregular margins and is deep with undermined edges B:-The chancroid ulcer has a smooth, indurated border and a smooth base C:-The genital herpes ulcer is often multiple, sub-epidermal and inflamed D:-If inguinal buboes with no ulcer is present, the most likely diagnosis is LGV Correct Answer:- Option-D Question60:-Regarding testing in genital ulcers which of the following statements is FALSE A:-(VDRL) test and a confirmatory treponemal test - fluorescent treponemal antibody absorption (FTA ABS) or microhemagglutinin-T. pallidum should be used to diagnose syphilis presumptively in all cases B:-HSV culture sensitivity approaches 100% in the vesicle stage but PCR assays for HSV DNA are more sensitive in the ulcerative stage C:-Optimally, the evaluation of a patient with a genital ulcer should include culture for Haemophilusducreyi D:-The diagnosis remains unconfirmed in more than half of patients (60%) with genital ulcers Correct Answer:- Option-D Question61:-Find the FALSE statement regarding HPV induced CIN. A:-HPV-16 infection is a very specific finding and can be found in only 2% of women with normal cervical cytology B:-HPV-18 is more specific than HPV-16 for invasive tumors C:-Metaplasia found at the squamocolumnar junction, begins in the subcolumnar reserve cells D:-As the CIN lesions become more severe, the HPV copy numbers decrease, and the capsid antigen disappears Correct Answer:- Option-A Question62:-The sensitivity of cervical cytology testing by Pap Smear for the detection of CIN 2 or 3 ranges from A:-60 to 95% B:-47% to 62% C:-20-30% D:-10-15% Correct Answer:- Option-B Question63:-Cervical conisation is indicated in all EXCEPT A:-ECC histologic findings are positive for CIN 2 or CIN 3 B:-Lack of correlation between cytology, biopsy and colposcopy C:-Type I transformation zone D:-Diagnosis of AGC-AIS Correct Answer:- Option-C Question64:-The following drugs are approved for treatment of Genitourinary Syndrome of Menopause (GSM) EXCEPT A:-Ospemifene B:-17 beta oestradiol C:-Paroxetine D:-DHEA Correct Answer:- Option-C Question65:-Following are the duties of a Registered Medical Practitioner under POCSO Act of India EXCEPT A:-The registered medical practitioner shall submit the report on the condition of the child within 48 hrs to the SJPU or local police B:-Provide prophylaxis for identified STD including prophylaxis for HIV and emergency contraception C:-Shall request for legal or magisterial requisition or other documentation prior to rendering such care D:-Options 1) and 3) Correct Answer:- Option-D Question66:-All are TRUE statements regarding female sterilisation in India EXCEPT A:-Laparoscopic tubal ligation can be done concurrently with second-trimester abortion and in the post-partum period only by an expert operator B:-The consent of the spouse is not required for sterilization C:-Clients should be married with female client below the age of 49 years and above the age of 22 years D:-The couple need have minimum one child whose age is above one year unless the sterilization is medically indicated Correct Answer:- Option-A Question67:-All the following statements are TRUE EXCEPT A:-BMI greater than 35 or weight greater than 100 kg, should receive 2 g of cefazolin as preoperative antibiotic prophylaxis B:-In as many as 50% of postoperative patients, Febrile morbidity in first 48 hours is noninfectious and does not need antibiotics C:-Even a single dose of perioperative prophylactic antibiotic decreases the incidence of postoperative urinary tract infection from 40% to as low as 4% D:-Incidence of wound infections could be decreased by hexachlorophene showers before surgery and shaving of the woundsite just prior to incision Correct Answer:- Option-D Question68:-All the following are TRUE about Enhanced Recovery-ERAS Protocol EXCEPT A:-Preoperative carbohydrate loading B:-The use of liberal antiemetics including preoperative steroids C:-Avoiding routine nasogastric tube and drains D:-Adequate pain relief with opiods Correct Answer:- Option-D Question69:-Find the CORRECT statement regarding laparoscopy. A:-To avoid injury to the deep inferior epigastric vessels, the lateral trocar should be placed 3 to 4 cm medial to the medial umbilical ligament B:-Transillumination of the abdominal wall from within permits the identification of the deep inferior epigastric vessels in most thin women C:-The amount of gas transmitted into the peritoneal cavity should depend on the measured intraperitoneal pressure, not the volume of gas inflated D:-Hasson's open entry method is better than the closed method in preventing organ injury Correct Answer:- Option-C Question70:-Find the FALSE statement. A:-Data are insufficient regarding fasting times for clear liquids and the risk of pulmonary aspiration during labor B:-Modest amounts of clear liquids can be allowed in uncomplicated laboring women C:-Obvious solid foods are best avoided D:-A fasting period of 6 to 8 hours for solid food is recommended for uncomplicated parturients prior to undergoing Category I, II and III Caesarean sections Correct Answer:- Option-D Question71:-Findings consistent with an Acute Peripartum or intrapartum event leading to Hypoxic-Ischemic Encephalopathy are the following EXCEPT A:-Apgar score < 5 at 5 and 10 minutes B:-Umbilical arterial pH < 7.0 and/or base deficit > 12 mmo I/L
C:-Sentinel hypoxic or ischemic event occurring immediately before or during delivery
D:-Spastic diplegia and ataxia type cerebral palsy
Correct Answer:- Option-D
Question72:-Absolute contraindications to External Cephalic Version in Breech include all EXCEPT
A:-Oligohydramnios
B:-Antepartum hemorrhage
C:-Any contraindication to labour
D:-Multiple gestation
Correct Answer:- Option-A
Question73:-Which of the following is used to deliver an arrested after coming head in assisted breech delivery of chin to pubis rotated baby ?
A:-Scanzoni maneuver
B:-Pajot’s maneuver
C:-Prague maneuver
D:-Kristellar maneuver
Correct Answer:- Option-C
Question74:-Which is NOT a contraindication to vacuum extraction ?
A:-Brow presentation
B:-Fetal bleeding disorder or demineralization disorder
C:-Previous fetal scalp sampling
D:-Less than 34 weeks of gestation
Correct Answer:- Option-C
Question75:-All the following are TRUE EXCEPT
A:-Third-and fourth-degree lacerations at delivery are associated with an increased risk of fecal incontinence (OR 2-3)
B:-Patients with occult anal sphincter tears are 8 times more likely to have fecal incontinence
C:-There is sufficient evidence to support primary elective cesarean delivery for the purpose of preserving fecal continence
D:-Both forceps and vacuum-assisted vaginal delivery significantly increase this risk, with vacuum being less traumatic than forceps
Correct Answer:- Option-C
Question76:-Using WHO classification for Semen Analysis interpretation, choose the FALSE statement is
A:-The normal lower limit for normal morphology is 4%
B:-The normal lower limit for sperm motility is 32%
C:-Viability should be at least 58%
D:-The normal lower limit for sperm concentration is 39 million/mL
Correct Answer:- Option-D
Question77:-Contraindications to using Gonadotropins for ovulation induction in infertile women include all EXCEPT
A:-Uncontrolled thyroid and adrenal dysfunction
B:-Hypogonadotropichypogonadism due to space occupying lesions
C:-Sex hormone-dependent tumors of the reproductive tract and accecssory organs
D:-Kallmann syndrome
Correct Answer:- Option-D
Question78:-All the following are methods to decrease OHSS EXCEPT
A:-HCG trigger
B:-GnRH antagonists
C:-Invitro oocyte maturation
D:-Cabergoline
Correct Answer:- Option-A
Question79:-All statements about heterotopic pregnancy are TRUE EXCEPT
A:-1 in 30000 in spontaneous conceptions, as high as 1% with IVF treatment
B:-Only 26% of heterotopic cases can be diagnosed with transvaginal US
C:-Most often diagnosed in the first 5 to 8 weeks of gestation
D:-After treatment of a heterotopic gestation, the overall delivery rate for the intrauterine pregnancy is only 10-20%
Correct Answer:- Option-D
Question80:-All the following are independent prognostic variables in endometrial cancer EXCEPT
A:-Myometrial invasion
B:-Peritoneal cytology
C:-Tumor size
D:-Lymph node metastasis
Correct Answer:- Option-B
Question81:-Find the INCORRECT statement regarding endometrial cancer.
A:-Inactivation of the PTEN tumor-suppressor gene is the most common genetic defect in type I cancers
B:-Type I cancers arise from its precursor Endometrial Intraepithelial Carcinoma (EIC)
C:-Type II cancers frequently demonstrate alterations in HER2/neu,p53,p16,E-cadherin and loss of LOH
D:-Type II endometrial cancer appears to be unrelated to high estrogen levels and often develops in nonobese women
Correct Answer:- Option-B
Question82:-All are TRUE regarding Leiomyosarcoma EXCEPT
A:-This malignancy has no relationship with parity
B:-A history of prior pelvic radiation can be elicited in about 50% of women with uterine LMS
C:-Surgery is the mainstay of treatment for uterine LMS
D:-Retroperitoneal lymphatic spread is rare in women with early-stage disease and lymphadenectomy is not associated with a survival advantage
Correct Answer:- Option-B
Question83:-All the following are TRUE about TTTS EXCEPT
A:-Although growth discordance or growth restriction may be found with TTTS, these per se are not considered diagnostic criteria
B:-TTTS is diagnosed in a monochorionicdiamnionic pregnancy when there is oligamnios SVP<2 cm in one sac and polyhydramnios SVP>8 in the other sac
C:-Sonography surveillance of pregnancies at risk for TTTS should begin at 16 weeks and continue every 2 weeks
D:-The discrepancies in amnionic fluid volumes of TTTS are also typically seen in Twin Anaemia Polycythemia Sequence (TAPS)
Correct Answer:- Option-D
Question84:-Find the FALSE statement regarding 2018 FIGO staging of cancer cervix.
A:-Tumour of size ≥ 2 cm and < 4 cm confined to the cervix is stage IB2 B:-Imaging and pathology can be used, where available, to supplement clinical findings with respect to tumor size and extent, in all stages C:-The involvement of lymph nodes are not part of staging D:-The lateral extent of the lesion is no longer considered Correct Answer:- Option-C Question85:-The boundaries of paravesical space include all EXCEPT A:-The obliterated umbilical artery running along the bladder medially B:-The obturator internus muscle along the pelvic sidewall laterally C:-The uterosacral ligament posteriorly D:-The pubic symphysis anteriorly Correct Answer:- Option-C Question86:-All are TRUE regarding serous borderline ovarian tumours EXCEPT A:-10% of all ovarian serous tumors are of borderline type and 50% occur before the age of 40 years B:-Up to 40% of serous borderline tumors are associated with spread beyond the ovary C:-Up to 10% of women with ovarian serous borderline tumors and extraovarian implants may have invasive implants D:-Borderline serous tumors may harbor foci of stromal microinvasion and if so, should be managed as aggressive serous carcinomas Correct Answer:- Option-D Question87:-In Kyoto (Querlou and Morrow) classification, Nerve sparing Radical Hysterectomy is A:-Type B B:-Type C1 C:-Type C2 D:-Type D2 Correct Answer:- Option-B Question88:-All are TRUE about Germ cell tumours EXCEPT A:-In patients with stage IA dysgerminoma, unilateral oophorectomy alone results in a 5-year disease-free survival rate of greater than 95% B:-Patients with stage IA, grade 1 immature teratoma need 4 cycles of BEP adjuvant therapy after surgery C:-All patients with Endodermal Stromal Tumours (EST) should be treated with chemotherapy shortly after recovering from surgery ovarian dysfunction of failure D:-Transient ovarian failure is common with platinum-based chemotherapy for germ cell tumours and majority will have successful childbearing in the future Correct Answer:- Option-B Question89:-All the following statements regarding Granulosa cell tumours of the ovary are TRUE EXCEPT A:-Endometrial cancer occurs in association with granulosa cell tumors in at least 5% of cases B:-25-50% of Granulosa cell tumours are associated with endometrial hyperplasia C:-Granulosa cell tumors may also produce androgens and cause virilization D:-Juvenile granulosa cell tumors of the ovary are rare and behaves more aggressively than the adult type Correct Answer:- Option-D Question90:-All the following statements about intrahepatic cholestasis of pregnancy are TRUE EXCEPT A:-bile acids are cleared incompletely and accumulate in plasma but the cause is unclear B:-pruritus shows predilection for the soles and may precede laboratory findings by several weeks C:-total plasma concentrations of bilirubin exceed 8 mg/dL and serum transaminases exceed 500 in 30% patients D:-ursodeoxycholic acid relieves pruritus and improves fetal outcome better than steroids and cholestyramine Correct Answer:- Option-C Question91:-All the statements about sickle cell anaemia in pregnancy are TRUE EXCEPT A:-Sickle-cell trait does not appear to be associated with increased perinatal mortality, low birthweight or pregnancy-induced hypertension B:-In Sickle cell disease there is no categorical contraindication to vaginal delivery, and caesarean delivery is reserved for obstetrical indications C:-Routine prophylactic blood transfusions during labour is recommended to reduce painful crises in Sickle cell anaemia D:-Antenatal folic acid supplementation with 4 mg daily throughout pregnancy is needed to support rapid red blood cell turnover Correct Answer:- Option-C Question92:-All the statements about thrombocytopenia in pregnancy are TRUE EXCEPT A:-A platelet count of < 80,000/L should trigger an evaluation for etiologies other than gestational thrombocytopenia B:-Hypertensive disorders account for 21% of thrombocytopenia in pregnancy C:-In ITP complicating pregnancy, therapy with steroids is considered if the platelet count is below 30,000 to 50,000/L D:-Maternal platelet counts have strong correlation with fetal platelet counts and caesarean delivery is recommended if platelet count is < 50,000 on fetal blood sampling Correct Answer:- Option-D Question93:-All the following statements regarding diabetes in pregnancy are TRUE EXCEPT A:-Periconceptional HbA1C should be kept under 6.5% in pregestational diabetic women B:-MSAFP levels may be lower in diabetic pregnancies and the incidence of congenital cardiac anomalies is five fold in mothers with diabetes C:-Ultra short acting insulin analogues starts acting in 30 minutes, peaks in 2 hrs minutes and is good for preprandial glycemic control in pregnancy D:-Insulin therapy is typically added if fasting levels persistently exceed 95 mg/dL after medical nutrition therapy Correct Answer:- Option-C Question94:-All the statements about thyroid in pregnancy are TRUE EXCEPT A:-Women with TPO antibodies are at increased risk for progression of thyroid disease and postpartum thyroiditis B:-It is recommended that women avoid pregnancy for 1 month after radioablative therapy with iodine 131 C:-Pregnancy is associated with an increased thyroxine requirement in approximately a third of supplemented women D:-Prophylthiouracil (PTU) is preferred in pregnancy because it partially inhibits the conversion of T4 to T3 and crosses the placenta less readily than methimazole Correct Answer:- Option-B Question95:-All the statements about SLE in pregnancy are TRUE EXCEPT A:-Fetal cell micro chimerism leads to the predilection for autoimmune disorders like SLE among women B:-In the presence of anti-Ro and Anti-La antibodies, the incidence of fetal myocarditis and heart block is as high as 20% C:-During pregnancy, lupus improves in a third of women, remains unchanged in a third and worsens in the remaining third D:-Hydroxychloroquine is not associated with congenital malformations and can be continued in pregnancy Correct Answer:- Option-B Question96:-All are TRUE about antiphospholipid antibody syndrome EXCEPT A:-Asherson syndrome is a rapidly progressive thromboembolic disorder due to a cytokine storm seen in antiphospolipid antibody syndrome B:-Approximately 60 percent of patients with APS have a positive lupus anticoagulant LAC assay alone C:-Heparin binds to beta 2 glycoprotein I and prevents binding of anticardiolipin andanti-beta 2 glycoprotein I antibodies to the syncytiotrophoblasts D:-Treatment using aspirin, anticoagulation and close monitoring has increased live birth rates to more than 70 percent in women with APS Correct Answer:- Option-B Question97:-All are TRUE about management of obstetric haemorrhage EXCEPT A:-The most important mechanism of action with internal iliac artery ligation is an 85-percent reduction in pulse pressure in those arteries distal to the ligation B:-ROTEM or TEG cannot diagnose coagulopathies stemming from platelet dysfunction or anti platelet drugs C:-Each single-donor apheresis six-unit bag raises the platelet count by approximately 5000/L D:-Dilutional coagulopathy that is clinically indistinguishable from DIC is the most frequent coagulation defect found with blood loss and multiple transfusions Correct Answer:- Option-C Question98:-All are TRUE about USS features of Placenta Accreta Spectrum (PAS) EXCEPT A:-loss of the normal hypoechoicretroplacentalzone between the placenta and uterus B:-placental vascular lacunae or lakes C:-distance between the uterine serosa-bladder wall interface and the retroplacental vessels measures < 10 mm D:-placental bulging into the posterior bladder wall Correct Answer:- Option-C Question99:-USS has a sensitivity of ____________ in suspected abruptio placenta. A:-24% B:-54% C:-81% D:-93% Correct Answer:- Option-A Question100:-All are TRUE about COVID-19 in pregnancy EXCEPT A:-It is associated with an almost three times greater risk of preterm birth (17%) B:-Majority of pregnant women (74%) may be asymptomatic C:-ICU admissions are not more common in pregnant women compared to nonpregnant women of the same age D:-Risk factors associated with hospital admissions include older age, obesity, diabetes and hypertension Correct Answer:- Option-C