d) Etoposide, Methotrexate, Actinomycin, followed by vincristine and cyclophosphamide
41. An 8-year-old girl presents with complaints of vaginal bleeding for two days. On examination, Tanner stage 2 sexual characteristics are noted. What is the most likely diagnosis?
a) Central precocious puberty
b) Delayed puberty
c) Peripheral precocious puberty
d) Premature thelarche
Key: a) Central precocious puberty
Explanation:
Central precocious puberty (CPP) results from early activation of the hypothalamic-pituitary-gonadal axis, leading to early puberty signs. It is more common than peripheral causes and requires evaluation with GnRH stimulation testing and brain MRI to rule out underlying pathology.
42. A 30-year-old woman presents with lower abdominal pain and mucopurulent vaginal discharge. On examination, her cervix is congested, edematous, erythematous, and bleeds on touch. What is the most appropriate treatment?
a) Benzyl penicillin
b) Metronidazole
c) Tetracycline
d) Fluconazole
Key: c) Tetracycline
Explanation:
The clinical presentation is suggestive of cervicitis, most commonly caused by Chlamydia trachomatis. Tetracycline (or doxycycline) is the preferred treatment according to BASHH guidelines.
43. A 28-year-old woman on oral contraceptive pills (OCPs) is diagnosed with tuberculosis and starts anti-tuberculosis therapy. Which drug in her regimen is most likely to reduce the effectiveness of OCPs?
a) Isoniazid
b) Rifampicin
c) Ethambutol
d) Pyrazinamide
Key: b) Rifampicin
Explanation:
Rifampicin is a potent inducer of cytochrome P450 enzymes, increasing the metabolism of OCPs and reducing their efficacy, necessitating alternative contraception.
44. A 60-year-old woman presents with severe back pain and kyphosis. Which of the following is the most appropriate first-line investigation?
a) X-ray thoracic spine
b) DEXA scan
c) CT scan
d) MRI spine
Key: a) X-ray thoracic spine
Explanation:
An X-ray is the initial investigation for suspected vertebral fractures in osteoporosis. A DEXA scan evaluates bone mineral density but does not detect fractures.
45. A G2P1 woman with twin pregnancy is in labor. The first twin has been delivered, but the second twin is in a transverse lie. Fetal heart rate is 100 bpm, and uterine contractions are absent. What is the next step in management?
a) External cephalic version
b) Emergency cesarean section
c) Internal podalic version
d) IV Syntocinon
Key: c) Internal podalic version
Explanation:
In a transverse second twin, internal podalic version (IPV) is performed to convert the fetus into a breech presentation for vaginal delivery. If unsuccessful, a cesarean section is considered.
46. A 35-year-old woman presents with secondary amenorrhea and cyclical hematuria following her third cesarean section. What is the most likely diagnosis?
a) Vesico-Vaginal Fistula
b) Uretero-Vaginal Fistula
c) Urethro-Vaginal Fistula
d) Vesico-Uterine Fistula
Key: d) Vesico-Uterine Fistula
Explanation:
Vesico-uterine fistula is a rare complication of cesarean section, presenting with menouria (menstrual blood in urine) and secondary amenorrhea due to the communication between the bladder and uterus.
47. An 80-year-old postmenopausal woman with ischemic heart disease and diabetes presents with procedentia (uterovaginal prolapse). She is classified as ASA 3. What is the most appropriate management?
a) Vaginal hysterectomy with anterior-posterior repair
b) Sacrospinous fixation
c) Colpocleisis
d) Pessary with local estrogens
Key: c) Colpocleisis
Explanation:
Colpocleisis is a non-invasive surgical option for elderly, high-risk surgical candidates with advanced pelvic organ prolapse who no longer desire vaginal function.
48. A couple presents with unexplained primary infertility for two years. What is the most appropriate next step in management?
a) Intracytoplasmic sperm injection (ICSI)
b) Intrauterine insemination (IUI)
c) In vitro fertilization (IVF)
d) Gamete intrafallopian transfer (GIFT)
Key: c) In vitro fertilization (IVF)
Explanation:
According to NICE guidelines, IVF is the preferred treatment for unexplained infertility after two years of failed conception, as it improves pregnancy outcomes compared to IUI.
49. A G3P2 woman with a previous cesarean section followed by VBAC presents at 36 weeks with an ultrasound showing a flexed breech fetus. What is the most appropriate management?
a) Elective cesarean section at 37 weeks
b) Elective cesarean section at 39 weeks
c) Assisted vaginal breech delivery
d) Perform external cephalic version (ECV)
Key: d) Perform external cephalic version (ECV)
Explanation:
ECV is the recommended first-line approach for breech presentation at 36 weeks unless contraindicated. It reduces the need for cesarean delivery.
50. A 28-year-old woman presents with yellowish frothy vaginal discharge, pruritus, and lower abdominal pain. Speculum examination reveals strawberry cervix with punctate hemorrhages. What is the most appropriate treatment?
a) Oral fluconazole
b) Benzathine penicillin
c) Metronidazole
d) Clindamycin
Key: c) Metronidazole
Explanation:
Trichomonas vaginalis infection presents with frothy discharge and a "strawberry cervix". Metronidazole is the treatment of choice for both the patient and her partner.
51. A 50-year-old woman presents with persistent urine leakage from the vagina after recent radiotherapy for cervical cancer. Examination confirms a vesicovaginal fistula (VVF). What is the best time to repair the fistula?
a) After 1 month of radiotherapy
b) After 3 months of radiotherapy
c) After 6 months of radiotherapy
d) Immediately
Key: b) After 3 months of radiotherapy
Explanation:
The optimal timing for surgical repair of a radiation-induced vesicovaginal fistula (VVF) is 3 months after radiotherapy to allow tissue healing and reduce recurrence risk.
52. A postmenopausal woman presents with an adnexal mass on ultrasound. Which of the following statements is most appropriate regarding the Risk of Ovarian Malignancy Algorithm (ROMA)?
a) CA-125 is part of this algorithm
b) HE-4 marker is part of ROMA
c) It checks menopausal status only
d) It helps in non-surgical evaluation of ovarian mass
Key: d) It helps in non-surgical evaluation of ovarian mass
Explanation:
The ROMA algorithm incorporates CA-125 and HE-4 biomarkers along with menopausal status to classify ovarian masses into low or high risk for malignancy, assisting in clinical decision-making before surgery.
53. A 30-year-old woman developed secondary amenorrhea one year after postpartum hemorrhage (PPH) that required surgical uterine evacuation. What is the most likely diagnosis?
a) Asherman syndrome
b) Hyperprolactinemia
c) Sheehan syndrome
d) Ovarian insufficiency
Key: a) Asherman syndrome
Explanation:
Asherman syndrome occurs due to intrauterine adhesions following uterine curettage, leading to secondary amenorrhea and infertility. It is a common complication of postpartum hemorrhage requiring surgical evacuation.
54. A 35-year-old woman underwent a large loop excision of the transformation zone (LLETZ) for cervical dysplasia. Which of the following is the most common long-term complication?
a) Cervical incompetence
b) Chronic pelvic infection
c) Fecal incontinence
d) Urinary incontinence
Key: a) Cervical incompetence
Explanation:
LLETZ may lead to cervical shortening and incompetence, increasing the risk of second-trimester pregnancy loss and preterm birth due to weakened cervical support.
55. A 32-year-old nulliparous woman, married for 5 years, presents with lower abdominal pain and dyspareunia. Ultrasound shows bilateral tubo-ovarian masses (5×5 cm) with free fluid in the pouch of Douglas. What is the most appropriate management?
a) Laparoscopy
b) Colposcopy
c) Culdocentesis
d) Hysterosalpingography
Key: a) Laparoscopy
Explanation:
Laparoscopy is both diagnostic and therapeutic for suspected tubo-ovarian abscess (TOA), allowing drainage, adhesiolysis, and collection of samples for microbiology.
56. During a forceps-assisted delivery, you are teaching a junior trainee about the best type of episiotomy to reduce the risk of severe perineal tears. Which of the following is the most appropriate?
a) Mediolateral episiotomy at 60° from the midline
b) Mediolateral episiotomy at 45° from the midline
c) Mediolateral episiotomy at 30° from the midline
d) Midline episiotomy
Key: a) Mediolateral episiotomy at 60° from the midline
Explanation:
A 60-degree mediolateral episiotomy at crowning is preferred as it significantly reduces the risk of third and fourth-degree perineal tears compared to a midline episiotomy, which has a higher risk of severe perineal injury.
57. A 55-year-old postmenopausal woman presents with a complex ovarian cyst (solid / 3 cm) on ultrasound. Her CA-125 level is 19 IU/ml, and she is asymptomatic. What is the most appropriate interpretation of the Risk of Malignancy Index (RMI)?
a) Risk of malignancy is <3%
b) Risk of malignancy is 10%
c) Risk of malignancy is 30%
d) Risk of malignancy is 50%
Key: c) Risk of malignancy is 3%
Explanation:
The RMI score is calculated as U x M x CA-125. A score of >200 suggests a high risk, while <200 suggests a low to moderate risk of ovarian malignancy.
58. A 32-year-old woman with a history of three first-trimester miscarriages undergoes cytogenetic analysis of products of conception, revealing a chromosomal abnormality. What is the most appropriate next step?
a) Hysteroscopy
b) Parental karyotyping
c) Endometrial biopsy
d) Thrombophilia screening
Key: b) Parental karyotyping
Explanation:
If products of conception reveal chromosomal abnormalities, parental karyotyping is recommended to identify translocations or genetic defects that may affect future pregnancies.
59. A couple with a history of one child affected by congenital adrenal hyperplasia (CAH) presents for preconception counseling. What is the best intervention if the next baby is also affected?
a) Parental karyotyping
b) MRI of fetal adrenal glands
c) Administration of dexamethasone to the mother during pregnancy
d) Newborn screening after delivery
Key: c) Administration of dexamethasone to the mother during pregnancy
Explanation:
Prenatal dexamethasone therapy is used to suppress excess fetal ACTH, preventing virilization in affected female fetuses in families with a history of CAH.
60. A woman with a post-term pregnancy (42 weeks) is being assessed for fetal well-being. Which of the following is the best predictor of poor fetal outcome?
a) Amniotic fluid volume
b) Cardiotocography
c) Ratio of MCA Doppler to Umbilical Artery Doppler
d) Uterine artery Doppler
Key: a) Amniotic fluid volume
Explanation:
Oligohydramnios (low amniotic fluid volume) is a significant predictor of fetal distress in post-term pregnancies due to reduced placental perfusion.
61. A 32-year-old pregnant woman with gestational diabetes mellitus (GDM) is admitted to the labor room with mild vaginal bleeding at 20 weeks. She had a previous cesarean section, and a rescue cervical cerclage is planned. Which of the following is a contraindication to cerclage?
a) Gestational Diabetes Mellitus
b) vaginal bleeding
c) Previous cesarean section
d) Maternal pyrexia
Key: b) vaginal bleeding
Explanation:
Antepartum hemorrhage is a contraindication for rescue cervical cerclage, as it increases the risk of fetal and maternal complications. Active vaginal bleeding suggests placental pathology, and cerclage in such cases can worsen outcomes.
62. A 57-year-old postmenopausal woman presents with abdominal distention. Ultrasound shows a multiloculated right ovarian cyst with solid areas and ascites. Her CA-125 level is 350 IU/ml. What is the calculated RMI score?
a) 85
b) 1250
c) 1500
d) 3150
Key: d) 3150
Explanation:
The Risk of Malignancy Index (RMI) is calculated as:
RMI = U × M × CA-125
- U (Ultrasound score) = 3 (multiloculated cyst + solid areas + ascites)
- M (Menopausal status) = 3 (postmenopausal)
- CA-125 = 350
RMI = 3 × 3 × 350 = 3150
A score >200 is high risk for ovarian malignancy.
63. A 28-week pregnant woman presents with abdominal pain and regular uterine contractions. On vaginal examination, the cervix is closed, central, and 2 cm long. What is the most appropriate management?
a) Nifedipine
b) Atosiban
c) Magnesium sulfate
d) Indomethacin
Key: a) Nifedipine
Explanation:
Calcium channel blockers (Nifedipine) are first-line tocolytics for threatened preterm labor.
- Atosiban (oxytocin receptor antagonist) is an alternative.
- Indomethacin is used before 28 weeks to inhibit prostaglandin synthesis.
- Magnesium sulfate is used for neuroprotection, not as a primary tocolytic.
64. A G3P1+1 woman with a history of left salpingectomy for ectopic pregnancy presents at 8 weeks gestation with vaginal spotting. Ultrasound shows an empty uterus and a right-sided 3 cm adnexal mass. Serum beta-hCG is 5700 mIU/mL. What is the best treatment option?
a) Expectant management
b) Methotrexate therapy
c) Laparoscopy and salpingectomy
d) Laparotomy and salpingectomy
Key: b) Methotrexate therapy
Explanation:
Methotrexate is preferred for hemodynamically stable patients with:
- Adnexal mass <4 cm
- Beta-hCG <5000–6000 mIU/mL
- No rupture
Laparoscopy is indicated for larger masses, rupture, or high hCG levels.
65. A 25-year-old woman underwent suction curettage for molar pregnancy. Her beta-hCG normalized within 4 weeks. When should she have beta-hCG follow-up?
a) 6 weeks after suction evacuation
b) 6 months after suction evacuation
c) 6 months after normalization of beta-hCG
d) 12 months after normalization of beta-hCG
Key: b) 6 months after suction evacuation
Explanation:
RCOG guidelines recommend beta-hCG follow-up for 6 months post-molar evacuation if beta-hCG normalizes within 56 days. If normalization takes longer, follow-up is extended to 12 months to detect gestational trophoblastic neoplasia (GTN) early.
67. A 50-year-old woman presented in the gynecology OPD with urinary urgency. She is diagnosed with detrusor instability. The best management is:
a) Behavioural therapy
b) Behavioural therapy and tolterodine
c) Extended-release oxybutynin
d) Extended-release tolterodine
Key: d) Extended-release tolterodine
Explanation:
Overactive bladder (OAB)/detrusor overactivity is best managed with extended-release antimuscarinic agents like tolterodine or oxybutynin. Tolterodine is preferred due to fewer side effects (dry mouth, constipation) compared to oxybutynin. Behavioural therapy alone may not be sufficient for symptom control.
68. A patient had a miscarriage at 8 weeks. She had a history of stroke last year and developed DVT two years back, for which she was treated with anticoagulants. The most likely diagnosis would be:
a) Cardiovascular disease
b) Factor V deficiency
c) Anti-phospholipid antibody syndrome (APS)
Key: c) Anti-phospholipid antibody syndrome (APS)
Explanation:
APS is an autoimmune prothrombotic disorder associated with:
- Recurrent pregnancy loss (especially in the first trimester)
- Arterial and venous thromboembolism (DVT, stroke)
- Positive antiphospholipid antibodies
Factor V deficiency is associated with bleeding, not thrombosis.
69. A 40-year-old primigravida underwent ultrasound at 21 weeks, reporting a small baby with a choroid plexus cyst. The most likely diagnosis is:
a) Down’s syndrome
b) Fragile X syndrome
c) Turner’s syndrome
d) Edward’s syndrome
Key: d) Edward’s syndrome (Trisomy 18)
Explanation:
Choroid plexus cysts are a soft marker for Edward’s syndrome (Trisomy 18), which is associated with:
- Growth restriction
- Multiple congenital anomalies
- High mortality rate
70. A 32-year-old nulliparous woman with primary infertility for 7 years underwent laparoscopy, which revealed a 2 cm ovarian cyst and endometriotic spots on the peritoneum with bilateral patent tubes. The best option for her fertility would be:
a) Danazol
b) Medroxyprogesterone
c) Surgery
d) Goserelin
Key: c) Surgery
Explanation:
Laparoscopic excision or ablation of endometriotic lesions improves fertility outcomes in minimal/mild endometriosis by:
- Restoring normal pelvic anatomy
- Reducing inflammation
- Improving implantation rates
Medical therapy (Danazol, Goserelin, Medroxyprogesterone) suppresses ovulation and is not recommended for women actively trying to conceive.
71. A 22-year-old nulliparous sexually active female presented with vaginal discharge associated with itching. The most appropriate diagnostic test would be:
a) Endocervical swab for culture and sensitivity
b) Culture for chlamydia
c) High vaginal swab (HVS) for culture and sensitivity
Key: c) HVS for culture and sensitivity
Explanation:
High vaginal swab (HVS) culture is the for diagnosing vaginal infections, including Candida, Trichomonas vaginalis, and Bacterial Vaginosis. Endocervical swabs are used for gonorrhea and chlamydia screening.CHOOSE VVS IF PRESENT
72. A woman had an induced abortion at a private clinic. The doctor found fatty tissue during evacuation. The most likely complication would be:
a) Molar pregnancy
b) Uterine perforation
c) Gut injury
d) Infection
Key: b) Uterine perforation
Explanation:
Fatty tissue suggests adipose tissue from the omentum or bowel, indicating uterine perforation. Uterine perforation can cause gut injury, hemorrhage, and infection. Immediate surgical evaluation is required.
73. A G3P2+0 woman presented with labour pains for two hours. On examination:Three palpable uterine contractions in 10 minutes, lasting 30 seconds; Cervical os: 4 cm dilated, 1.5 cm long;Vertex at -3 station, membranes intact ;CTG: Reactive
The most appropriate management would be:
a) Spontaneous progress of labour
b) Amniotomy and oxytocin augmentation
c) Amniotomy and spontaneous progress of labour
d) Augmentation with syntocinon followed by ARM
Key: a) Spontaneous progress of labour
Explanation:
She is in early active labor (4 cm dilation) with normal progress and a reactive CTG. No intervention is required unless labour progress is slow or fetal distress occurs.
74. A 38-year-old woman has a family history of congenital anomalies. Her husband is 50 years old. She thinks his age is a risk factor for chromosomal anomalies. What is the best maternal age to perform amniocentesis or CVS to rule out congenital anomalies?
a) Above 35 years of age
b) Above 40 years of age
c) There is no paternal age risk
d) Above 45 years of age
Key: b) Above 40 years of age
as risk is 1%
75. A 29-year-old pregnant woman with HIV came to the antenatal clinic with viral load <50 copies/ml. What is the most important step to reduce mother-to-child transmission?
a) Antiretroviral therapy
b) Elective cesarean section at term
c) Exclusive breastfeeding of the baby
Key: a) Antiretroviral therapy
Explanation:
The most effective intervention to reduce HIV transmission to the baby is continued antiretroviral therapy (ART) throughout pregnancy, delivery, and postpartum.
- Elective cesarean section is only indicated if the viral load >1000 copies/ml.
- Exclusive breastfeeding is not recommended in high-resource settings, where formula feeding is available.
76. A G2P1 with previous SVD, came at 38 weeks of gestation in active labor. On examination:6 cm dilated with ruptured membranesFetal nose, eyes, and lips palpable but chin is directed posteriorly ;FHR = 140 beats/min, CTG is reactive ;Pelvis is adequate
The most appropriate management would be:
a) Spontaneous vaginal delivery
b) Emergency cesarean section
c) Internal podalic version with breech extraction
d) Manual conversion from face to vertex on full dilatation
Key: b) Emergency cesarean section
Explanation:
The fetus is in a mentoposterior (face) presentation, which is unlikely to deliver vaginally due to chin posterior rotation. Emergency cesarean section is recommended unless the face rotates to mentoanterior position, which is rare. Internal podalic version and breech extraction are not appropriate in singleton pregnancies.
77. A parent brought their 14-year-old daughter who was raped. The girl looks healthy and asymptomatic. You are unaware of the HIV status of the rapist. What is the most appropriate management?
a) Perform test after 6 months
b) STI testing is unimportant
c) Immediate testing for STIs
Key: c) Immediate testing for STIs
Explanation:
Immediate testing for STIs(WITHIN 72 HOURS ), including HIV, gonorrhea, chlamydia, syphilis, and hepatitis B should be performed as part of post-assault care. Repeat testing at 6 weeks, 3 months, and 6 months is recommended for HIV. PEP (post-exposure prophylaxis) for HIV should be initiated within 72 hours if indicated.
78. A 35-year-old G2P1 woman, who is Rh-negative, presents at 28 weeks gestation after a fall at home. She is asymptomatic, and fetal movements are normal. What is the most appropriate management?
a) Kleihauer-Betke test and administer Anti-D immunoglobulin
b) Immediate induction of labor
c) Observe for 24 hours without intervention
d) Perform an urgent amniocentesis
Key: a) Kleihauer-Betke test and administer Anti-D immunoglobulin
Explanation:
In Rh-negative pregnant women, any abdominal trauma or risk of fetal-maternal hemorrhage warrants:
- Kleihauer-Betke test (to assess fetal red cell transfer)
- Anti-D immunoglobulin administration
79. A 32-year-old woman at 34 weeks gestation presents with sudden severe upper abdominal pain and vomiting. On examination, she has RUQ tenderness and mild jaundice. Her ALT is 250 IU/L, AST is 220 IU/L, and platelets are 80,000/mm³. The most likely diagnosis is:
a) Acute fatty liver of pregnancy (AFLP)
b) HELLP syndrome
c) Viral hepatitis
d) Cholecystitis
Key: b) HELLP syndrome
Explanation:
HELLP syndrome (Hemolysis, Elevated Liver enzymes, and Low Platelets) presents in the third trimester with:
- RUQ/epigastric pain
- Elevated liver enzymes
- Thrombocytopenia (<100,000)
AFLP also causes liver dysfunction but is associated with hypoglycemia, coagulopathy, and encephalopathy.
80. A 31-year-old woman (P1+1) with previous SVD and a history of ruptured ectopic pregnancy presents to the ER with amenorrhea of 2 months and lower abdominal pain. She is a smoker (5 cigarettes/day) and has had an IUCD for 2 years while also taking oral contraceptive pills (OCPs). Her UPT is positive. The most likely risk factor for repeat ectopic pregnancy is:
a) IUCD
b) Previous history of ectopic pregnancy
c) Cigarette smoking
d) Oral contraceptive pills
Key: b) Previous history of ectopic pregnancy
Explanation:
A previous ectopic pregnancy is the strongest risk factor for repeat ectopic pregnancy. Other risk factors (smoking, IUCD, and OCPs) contribute but are less significant compared to a history of prior ectopic pregnancy.
81. A 23-year-old patient presented with the complaint of watery vaginal discharge since 2 months following SVD at home after a difficult, prolonged labor. Speculum examination reveals a 3 cm hole in the anterior vaginal wall. The most appropriate time to repair this vesicovaginal fistula (VVF) is:
a) After 3 months
b) After 1 month
c) After 4 months
d) After 1 week
82. A primigravida came at 16 weeks with cough. She is a chronic smoker. Which of the following risk factors is not associated with her condition?
a) Pre-eclampsia
b) Sudden infant death syndrome (SIDS)
c) Low birth weight
d) Preterm labor
e) PPROM
Key:
83. A woman with A+ve blood group presented in OPD for routine checkup. She had a previous history of early neonatal death due to extreme jaundice, and the baby required exchange transfusion. The best option for prevention of complications in the next pregnancy would be:
a) Antibody screening before conception
b) Antibody screening at booking only
c) Antibody screening not required as she is Rh +ve
d) Antibody screening at booking and at 28 weeks
Key: d) Antibody screening at booking and at 28 weeks
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