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FINAL TEST FOR GYNAECOLOGY AND OBSTETRICS - Complete MCQ Answers

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Q1. The main complaints and signs of myoma of uteri (Find correct - 3 answers)

• a) Metorrhagia
• b) Vomitting
• c) Cerebral disturbances
• d) Menorrhagia
• e) Infertility

1. Menorrhagia - the most common symptom, due to increased endometrial surface area and impaired uterine contractility
2. Metrorrhagia - irregular intermenstrual bleeding, especially with submucosal fibroids
3. Infertility - due to distortion of the uterine cavity, occlusion of fallopian tubes, or altered endometrial receptivity

DC Dutta's Textbook of Gynecology, 7th ed.: "Menorrhagia is the most common symptom... Infertility is present in about 2-10% of cases of fibroid."

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Q2. Symptom of endometriosis, EXCEPT

• Dysmenorrhoea (cyclical, progressive, secondary)
• Pelvic pain
• Dyspareunia (deep)
• Infertility

Swanson's Family Medicine Review: "Patients with endometriosis complain of dysmenorrhea... Other associated symptoms include dyspareunia, dyschezia, and low back pain. A history of infertility is also common." DC Dutta's Gynecology: Endometriosis presents with the classic triad of dysmenorrhea, dyspareunia, and infertility. Hirsutism has no association.

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Q3. Hypotheses for pre-menstrual syndrome, EXCEPT

• Altered levels of oestrogen and progesterone (hormonal fluctuation theory)
• Due to withdrawal of endorphins (opioid withdrawal theory)
• Involvement of psychological factors
• Involvement of thyrotrophin releasing hormone (TRH), prolactin, renin, aldosterone, prostaglandins

DC Dutta's Gynecology: "Decreased serotonin activity has been implicated in PMS. SSRIs (which increase serotonin) are effective treatment, confirming serotonin deficiency as the mechanism."

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Q4. The hallmark of pubertal breast development is

Williams Gynecology: "Thelarche (breast bud development) is driven primarily by oestrogen-stimulated ductular proliferation." DC Dutta's Gynecology: "The first change during puberty in the breast is ductular proliferation under oestrogen influence."

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Q5. Find the mistake - The following are types of sex cord stromal tumours

• Granulosa cell tumour (granulosa stroma cell tumour)
• Thecoma/fibroma
• Androblastoma (Sertoli-Leydig cell tumour)
• Gynandroblastoma

DC Dutta's Gynecology: "Dysgerminoma is a malignant germ cell tumour... Sex cord-stromal tumours include granulosa cell tumours, thecomas, fibromas, and Sertoli-Leydig cell (androblastoma) tumours." Berek & Novak's Gynecology: "Dysgerminoma is the most common malignant germ cell tumour of the ovary and is distinct from sex cord-stromal tumours."

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Q6. Clinical diagnosis of menopause

Textbook of Family Medicine: "Menopause is defined as the cessation of menstruation. It is a retrospective diagnosis that comes after a woman has not menstruated for 12 months." DC Dutta's Gynecology: "Menopause is diagnosed retrospectively after 12 months of amenorrhoea without any other cause." Williams Obstetrics: "Menopause is confirmed after 12 consecutive months of amenorrhea."

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Q7. Role of prostaglandins in primary dysmenorrhoea - false EXCEPT (i.e., find the TRUE statement)

• a) "Prostaglandins are synthesized under the action of oestrogen" - FALSE. Prostaglandins (PGF2α, PGE2) are synthesized under the action of progesterone (in the secretory phase). Oestrogen promotes endometrial growth; progesterone withdrawal triggers arachidonic acid release and prostaglandin synthesis.
• b) "Prostaglandins are released with maximum release during the proliferative phase" - FALSE. Maximum release is during menstruation (after progesterone withdrawal), not the proliferative phase.
• c) "Prostaglandin is a potent vasoconstrictor causing ischemia and hypoxia of myometrium leading to pain" - TRUE. PGF2α is a potent vasoconstrictor and stimulates myometrial contractions, causing uterine ischemia and hypoxia, which generates pain.
• d) "Prostaglandin causes decreased myometrial contraction" - FALSE. Prostaglandins increase myometrial contractions.

DC Dutta's Gynecology: "Prostaglandins (PGF2α) cause myometrial hypercontractility and vasoconstriction leading to uterine ischemia and pain in primary dysmenorrhoea."

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Q8. Which vaginal fornix is longest?

• The cervix is angled anteriorly
• The posterior wall of the vagina is longer than the anterior wall (9 cm vs 7.5 cm)
• The posterior fornix is in direct contact with the peritoneum of the pouch of Douglas (rectouterine pouch)

DC Dutta's Gynecology: "The posterior fornix is the deepest and is related to the pouch of Douglas." Gray's Anatomy: "The posterior fornix is the deepest recess, separated from the rectouterine pouch by only the vaginal wall and peritoneum."

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Q9. Duration of menstrual bleeding is increased in

• a) Menorrhagia - increased amount AND duration
• b) Polymenorrhoea - frequent periods (short cycle), normal duration
• c) Metrorrhagia - irregular bleeding between periods
• d) Metropathia haemorrhagica - irregular heavy bleeding due to anovulation

DC Dutta's Gynecology: "Menorrhagia is defined as excessive menstrual bleeding, either in amount (>80 mL) or duration (>7 days) or both, at regular intervals."

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Q10. Causes of severe abdominal pain, EXCEPT

• Ectopic pregnancy (rupture)
• Acute salpingo-oophoritis (PID)
• Twisted ovarian cyst (torsion)
• Torsion of subperitoneal myomata
• Red degeneration of fibroid

DC Dutta's Gynecology: "Cervical erosion/ectropion is usually asymptomatic and is discovered on routine examination. It may cause vaginal discharge and contact bleeding but NOT severe pain."

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Q11. Which part of vagina is more sensitive to hormonal influences?

DC Dutta's Gynecology: "The upper one-third of the vagina is Mullerian in origin and is more sensitive to hormonal changes, showing cyclical changes with the menstrual cycle."

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Q12. Indication of aspiration of pouch of Douglas, EXCEPT

• Pelvic abscess (to drain pus)
• Pelvic haematocele (to drain blood, e.g., in ectopic pregnancy)
• Pelvic endometriosis (to confirm diagnosis/drain chocolate cyst contents)
• Diagnosis of ectopic pregnancy (non-clotting blood)

DC Dutta's Gynecology: "Ovarian tumours are a contraindication to aspiration because of risk of rupture and spread of malignant cells."

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Q13. Offensive vaginal discharge - characteristic, EXCEPT

• a) Carcinoma of cervix
• b) Septic myomatous polypoid
• c) Septic abortion
• d) Carcinoma of body of uterus

DC Dutta's Gynecology: "Carcinoma cervix: offensive vaginal discharge is characteristic. Endometrial carcinoma: presents with watery blood-stained discharge - not primarily offensive."

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Q14. Most characteristic symptom of chronic pelvic inflammatory disease

• Low backache is characteristic (due to fibrosis and adhesions involving the pelvic ligaments and parametrium)
• Fever is more characteristic of ACUTE PID
• Dysuria and constipation can occur but are not the most characteristic symptoms

DC Dutta's Gynecology: "Chronic PID: The most characteristic symptom is low-grade pelvic aching and backache due to chronic inflammation and fibrosis."

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Q15. Increased risk factors for PID, EXCEPT

• Younger age (sexually active teenagers)
• Multiple sexual partners
• Increased intercourse frequency
• Use of IUD (intrauterine device - increases risk of PID, especially in first 3 weeks)

DC Dutta's Gynecology: "Oral contraceptive pills protect against PID by thickening cervical mucus and reducing menstrual blood flow. IUDs increase the risk." Williams Gynecology: "Combined oral contraceptives reduce the risk of symptomatic PID."

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Q16. Find MISTAKES (2) - HELLP syndrome means

• H = Hemolysis ✓ (option c - correct)
• E = Elevated Liver function tests ✓ (option d - correct, "EL" = Elevated Liver enzymes)
• L = Low Platelets = Thrombocytopenia ✓ (option b - correct)

• Proteinuria (option a) - Proteinuria is a feature of pre-eclampsia but NOT part of the HELLP acronym
• Hypertension (option e) - Hypertension is also a feature of pre-eclampsia but NOT part of the HELLP acronym itself. HELLP can rarely occur without hypertension.

Creasy & Resnik's Maternal-Fetal Medicine: "HELLP syndrome = Hemolysis, Elevated Liver enzymes, and Low Platelets. Hypertension and proteinuria are features of pre-eclampsia but are not included in the HELLP acronym." Williams Obstetrics: "HELLP syndrome is defined by hemolysis, elevated liver enzyme levels, and a low platelet count."

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Q17. Which is absent in eclamptic status tonic phase?

1. Premonitory stage - restlessness, twitching, rolling of eyeballs
2. Tonic stage - rigid body, head thrown back, jaw clenched, apnea (~30 sec)
3. Clonic stage - violent convulsions, tongue biting
4. Coma stage - unconsciousness

• Rigid body ✓ present
• Head thrown back ✓ present
• Twitching and rolling of eyeball ✓ present (actually these begin in premonitory and continue into tonic)
• Restlessness - present in premonitory but less prominent in tonic
• Coma - occurs AFTER the clonic phase

DC Dutta's Obstetrics: "Tonic stage: The whole body becomes rigid (opisthotonos), head thrown back, jaws clenched, apnoea. Coma occurs in the post-ictal phase, not during the tonic phase."

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Q18. Most common cause of uterine rupture

DC Dutta's Obstetrics: "The most common cause of uterine rupture in modern obstetrics is rupture of a previous caesarean scar." Williams Obstetrics: "Prior uterine surgery, especially classical caesarean delivery, is the most common predisposing factor for uterine rupture."

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Q19. Secondary amenorrhoea is defined as cessation of menses for

• >3 months (if cycles were previously regular)
• >6 months (if cycles were previously irregular)

DC Dutta's Gynecology: "Secondary amenorrhoea: cessation of menstruation for more than 6 months in a woman who has previously menstruated." Williams Gynecology: "Secondary amenorrhoea is conventionally defined as cessation of menses for 3 or more months in women with previously normal menstruation, or 6 months in women with oligomenorrhoea."

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Q20. Agents used to treat hirsutism, EXCEPT

• GnRH agonists (a) - suppress LH/FSH, reduce ovarian androgen production
• Oral contraceptives (b) - reduce free androgens by increasing SHBG; progestins with anti-androgenic activity
• Dexamethasone (d) - suppresses adrenal androgen production (useful in adrenal hirsutism)
• Spironolactone, finasteride, flutamide (other agents)

DC Dutta's Gynecology: "Management of hirsutism includes OCPs, anti-androgens (spironolactone, flutamide), GnRH analogues, and glucocorticoids. Bromocriptine is used for hyperprolactinaemia, not hirsutism."

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Q21. Most common factor of infertility

DC Dutta's Gynecology: "Male factor (sperm abnormalities) is the most common single identifiable cause of infertility, accounting for about 30-40% of cases."

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Q22. Ovulation may be indicated by all, EXCEPT

• Biphasic basal body temperature (BBT) graph ✓ - temperature rises 0.2-0.5°C post-ovulation due to progesterone
• Endometrial biopsy revealing secretory changes ✓ - progesterone causes secretory transformation
• Biphasic mucous cycle ✓ - cervical mucus is clear/stretchy pre-ovulation, thick post-ovulation
• Normal progesterone levels in luteal phase ✓ - confirms corpus luteum formation

DC Dutta's Gynecology: "Evidence of ovulation: BBT chart showing biphasic pattern, mid-luteal serum progesterone >5 ng/mL, secretory endometrium on biopsy. The LH surge (not prolactin) triggers ovulation."

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Q23. Where is oxytocin primarily synthesized?

Williams Obstetrics: "Oxytocin is synthesized in the hypothalamus (paraventricular and supraoptic nuclei) and stored in the posterior pituitary." DC Dutta's Obstetrics: "Oxytocin is produced in the hypothalamus and released from the posterior pituitary gland."

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Q24. APGAR score includes all, EXCEPT

Williams Obstetrics: "The APGAR score evaluates five signs: heart rate, respiratory effort, muscle tone, reflex irritability, and skin color. Blood pressure is not assessed."

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Q25. What is Chadwick sign?

Williams Obstetrics: "Chadwick sign: bluish-violet discoloration of the vaginal walls and cervix due to vascular engorgement, first noted at 6-8 weeks." DC Dutta's Obstetrics: "Chadwick's sign - bluish discolouration of the vagina - is a probable sign of pregnancy due to increased vascularity."

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Q26. All correlated with ovarian failure, EXCEPT

• Turner's syndrome (45,X) - gonadal dysgenesis
• Radiation - destroys primordial follicles
• Chemotherapy (especially alkylating agents)
• Ovarian surgery (reduces ovarian reserve)

DC Dutta's Gynecology: "OCPs suppress ovulation but do not damage ovarian reserve. Ovarian failure is caused by gonadal dysgenesis (Turner's), radiation, chemotherapy, and surgical oophorectomy."

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Q27. Etiology of primary dysmenorrhoea - most common

DC Dutta's Gynecology: "The pathogenesis of primary dysmenorrhoea is attributed to increased prostaglandin (especially PGF2α) production by the endometrium, causing uterine hypercontractility and ischemia." Williams Gynecology: "Excessive prostaglandin release from the endometrium is the primary mechanism of primary dysmenorrhoea."

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Q28. Main site of ectopic pregnancy

DC Dutta's Obstetrics: "The fallopian tube is the site of ectopic pregnancy in 95-97% of cases, with the ampullary portion being the commonest site." Williams Obstetrics: "More than 95% of ectopic pregnancies implant in the fallopian tube."

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Q29. Main causes of 1st trimester bleeding (Find correct 2)

• Abortion (miscarriage) - most common cause of 1st trimester bleeding (~15-20% of pregnancies)
• Ectopic pregnancy - second most common, presents at 6-8 weeks with bleeding + pain

• Placenta praevia (b) - presents in 3rd trimester (28+ weeks)
• Placenta abruption (c) - presents in 2nd/3rd trimester
• Uterine rupture (e) - typically in active labour or 3rd trimester in scarred uterus

DC Dutta's Obstetrics: "First trimester bleeding - causes: abortion (threatened, inevitable, incomplete, complete, missed), ectopic pregnancy, molar pregnancy." Williams Obstetrics: "Bleeding in the first trimester is most commonly due to abortion or ectopic pregnancy."

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Q30. Classification of placental abruption (Find correct 3)

1. Revealed (external) - blood tracks down between membranes and cervix, appears as vaginal bleeding
2. Concealed - blood collects behind the placenta, no external bleeding
3. Mixed - combination of both revealed and concealed

• Incompleted separation (b) - not a standard classification term
• Couvelaire uterus (e) - this is a complication of severe abruption (uteroplacental apoplexy), not a classification type

DC Dutta's Obstetrics: "Classification of abruptio placentae: (1) Revealed/external - 80%, (2) Concealed/internal - 20%, (3) Mixed - combination of both. Couvelaire uterus is a complication, not a classification." Williams Obstetrics: "Placental abruption is classified as revealed (external hemorrhage), concealed (retroplacental hemorrhage), or mixed."

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Summary Answer Sheet

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• DC Dutta's Textbook of Gynecology, 7th ed. (H.K. Dutta)
• DC Dutta's Textbook of Obstetrics, 9th ed.
• Williams Obstetrics, 25th ed. (Cunningham et al.)
• Williams Gynecology, 4th ed.
• Berek & Novak's Gynecology, 16th ed.
• Creasy & Resnik's Maternal-Fetal Medicine, 8th ed.

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CREDIT TEST - Obstetrics & Gynaecology: Complete MCQ Answers

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Q1. State the period of the first trimester

• First trimester: 1-14 weeks (weeks 1-13 completed, i.e., up to end of week 14 by some classifications)
• Second trimester: 15-28 weeks
• Third trimester: 29-42 weeks

DC Dutta's Obstetrics: "First trimester: 0-14 weeks. Second trimester: 14-28 weeks. Third trimester: 28-40 weeks."

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Q2. What are the 2 kinds of abortion? (Find 2)

1. Spontaneous abortion - occurs naturally without deliberate interference (miscarriage); accounts for ~15-20% of recognised pregnancies
2. Induced abortion - deliberate termination of pregnancy, either therapeutic (medical indication) or elective

DC Dutta's Obstetrics: "Abortion is classified as: (1) Spontaneous - occurring without any intervention, and (2) Induced - deliberate termination, which may be therapeutic or criminal." Williams Obstetrics: "Abortions are either spontaneous or induced."

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Q3. The abortion's parameters are

• Gestational age: <20-22 weeks (before fetal viability)
• Fetal weight: <500 grams (pre-viable)
• Without placenta (products of conception passed incompletely or completely)

DC Dutta's Obstetrics: "Abortion is defined as expulsion or extraction of the fetus or embryo weighing 500g or less (corresponding to approximately 20-22 weeks gestation) from its mother." Williams Obstetrics (25th ed.): "The World Health Organization defines abortion as expulsion or extraction of an embryo or fetus weighing 500 g or less."

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Q4. Find the mistake - Normal forms of pelvis

1. Gynaecoid - normal female type (~50%), round/oval inlet, most favourable for labour
2. Android - male-type, heart-shaped inlet, narrow
3. Anthropoid - oval inlet (AP diameter > transverse), long and narrow
4. Platypelloid - flat, wide transverse, short AP

DC Dutta's Obstetrics: "Caldwell-Moloy classification of pelvis: Gynaecoid, Android, Anthropoid, and Platypelloid. Oblique pelvis (Naegele's pelvis) is a deformed/abnormal pelvis, not a standard form."

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Q5. State the period of the third trimester

• First trimester: 1-14 weeks
• Second trimester: 14-28 weeks
• Third trimester: 28-42 weeks (from 28 weeks to term/42 weeks)

DC Dutta's Obstetrics: "Third trimester spans from 28 weeks to 40-42 weeks (term)."

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Q6. Which is the complete breech position?

• a) Footling position (crossed out)
• b) Knee position
• c) Frank position (crossed out)
• d) Transverse position

• Frank breech = hips flexed, knees extended (legs straight up, feet near head) - this is the MOST COMMON type
• Complete breech = hips and knees both flexed (feet near buttocks)
• Footling/incomplete = one or both feet presenting

DC Dutta's Obstetrics: "Complete breech: thighs flexed on abdomen, legs flexed on thighs (knee-chest position). Frank breech: thighs flexed on abdomen, legs extended on thighs."

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Q7. How long does the puerperium last?

• Immediate puerperium: first 24 hours
• Early puerperium: 2-7 days
• Late puerperium: up to 6 weeks

DC Dutta's Obstetrics: "Puerperium is the period following childbirth during which the reproductive organs return to their normal non-pregnant state. It lasts for 6 weeks (42 days)." Williams Obstetrics: "The puerperium is conventionally defined as the 6-week period following delivery."

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Q8. Normal anteroposterior diameter of pelvic inlet?

• True/Obstetric conjugate (AP diameter of inlet): 11 cm (from sacral promontory to posterior superior pubic symphysis)
• Diagonal conjugate: 12.5-13 cm (clinically measurable)
• External conjugate (Baudelocque): 20 cm

General Anatomy & Musculoskeletal (Thieme Atlas): "True conjugate = 11 cm (distance from sacral promontory to posterior border of symphysis)." DC Dutta's Obstetrics: "The true conjugate (obstetric conjugate) is 11 cm. This is the most important AP diameter of the pelvic inlet."

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Q9. Etiology of contracted pelvis (Find 3)

1. Rickets - childhood vitamin D deficiency causes softening and deformity of pelvic bones; leads to flat/contracted pelvis
2. Osteomalacia - adult form of vitamin D deficiency; progressive pelvic deformity
3. Tumours - pelvic/sacral tumours can deform the pelvis

DC Dutta's Obstetrics: "Causes of contracted pelvis include: rickets (most common in developing countries), osteomalacia, pelvic tumours, fractures, poliomyelitis, developmental anomalies."

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Q10. Forms of lochia - Find the mistake

1. Lochia rubra - days 1-4, red/bloody (blood, decidua, fetal membranes)
2. Lochia serosa - days 4-9, pink/brownish (serous fluid, leukocytes, decidua)
3. Lochia alba - days 10-14+, white/yellow (leukocytes, mucus, bacteria)

DC Dutta's Obstetrics: "Normal lochia: Rubra (days 1-4), Serosa (days 4-9), Alba (day 10 onwards). Purulent lochia indicates puerperal sepsis/endometritis."

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Q11. Types of abnormal position (Find 3)

• Sinciput - partial deflexion (sinciput/anterior fontanelle presents) - abnormal
• Brow - moderate deflexion (widest diameter presents) - abnormal, most difficult to deliver
• Face - maximum extension (mentum/chin presents) - abnormal

DC Dutta's Obstetrics: "Malpresentations of the fetal head: Sinciput presentation, Brow presentation, Face presentation. Vertex (occiput presenting) is the normal presentation."

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Q12. When does lactation start?

• Colostrum is produced from late pregnancy and immediately after delivery
• True milk (lactation) begins on day 3-4 postpartum due to the "milk let-down" response (prolactin surge after placental delivery)
• However, initiation of breast secretion starts within 1-2 days after delivery

• a) Immediate - this describes colostrum, not true lactation
• b) Before labour (3rd trimester) - colostrum production, not lactation
• c) 1-2 days after labour - lactogenesis I begins
• d) 3-4 days after labour - when true milk "comes in" (lactogenesis II)

DC Dutta's Obstetrics: "Lactation starts within 24-48 hours (1-2 days) of delivery, stimulated by the fall in placental oestrogen and progesterone and rise in prolactin."

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Q13. In breech presentation, the buttocks descend

DC Dutta's Obstetrics: "In breech presentation, engagement occurs with the bitrochanteric diameter (9.5 cm) entering the transverse diameter of the pelvic inlet."

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Q14. What are the phases of the menstrual cycle?

1. Menstruation (days 1-5): shedding of endometrium
2. Follicular/Proliferative phase (days 5-13): FSH stimulates follicle growth, oestrogen rises
3. Ovulation (day 14): LH surge triggers egg release
4. Luteal/Secretory phase (days 15-28): progesterone from corpus luteum

DC Dutta's Gynecology & Williams Obstetrics: "The menstrual cycle phases: Menstrual, Proliferative (Follicular), Ovulatory, and Secretory (Luteal)."

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Q15. Induced abortion is divided into (Find 2)

1. Medical abortion - using drugs (mifepristone + misoprostol, methotrexate + misoprostol)
2. Surgical/Mechanical abortion - vacuum aspiration (MVA/EVA), D&C, D&E

DC Dutta's Obstetrics: "Induced abortion: (1) Medical methods - mifepristone + prostaglandin; (2) Surgical methods - vacuum aspiration, dilatation and curettage/evacuation."

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Q16. At what days does ovulation occur?

Costanzo Physiology 7th ed.: "Ovulation occurs on day 14 of a 28-day cycle. Regardless of cycle length, ovulation typically occurs 14 days prior to menses." DC Dutta's Gynecology: "Ovulation occurs around day 14 in a 28-day cycle."

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Q17. Normal value of wrist index

• Small frame: <14 cm
• Medium frame: 14-16 cm
• Large frame: >16 cm

DC Dutta's Obstetrics: "Wrist index (circumference of wrist): Small pelvis <13.5 cm, medium 13.5-15 cm, large >15 cm. Normal value approximately 13-14 cm."

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Q18. In vertex presentation, the first mechanism of labour is

1. Engagement - biparietal diameter descends below pelvic inlet
2. Descent - progressive downward movement
3. Flexion - chin-to-chest to present smallest diameter
4. Internal rotation - occiput rotates anteriorly
5. Extension - head delivers under pubic arch
6. External rotation (Restitution) - head aligns with shoulders
7. Expulsion - shoulders and body delivered

DC Dutta's Obstetrics: "The mechanisms of labour: (1) Engagement, (2) Descent, (3) Flexion, (4) Internal rotation, (5) Crowning and extension, (6) Restitution and external rotation, (7) Expulsion." Williams Obstetrics: "Engagement is the first mechanism of labour, defined as descent of the biparietal plane below the pelvic inlet."

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Q19. Mid pelvis is divided into (Find 2)

• Wide part (upper - near inlet)
• Narrow part (lower - near outlet, at the level of ischial spines)

DC Dutta's Obstetrics: "The pelvic cavity is divided into a wider upper part and a narrower lower part. The narrowest part is at the level of the ischial spines (mid-pelvis)."

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Q20. When is immediate puerperium (in Russia)?

DC Dutta's Obstetrics (Russian edition context): "Immediate puerperium: first 2 hours postpartum. Monitoring every 15 minutes for haemorrhage, uterine tone, blood pressure, and pulse."

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Q21. Find the mistake - Temporary forms of contraception

• Condom - barrier method, temporary ✓
• Implanon (etonogestrel implant) - long-acting but reversible ✓
• IUD (intrauterine device) - long-acting but reversible ✓

DC Dutta's Gynecology: "Temporary contraceptive methods include barrier methods, hormonal methods, IUDs, and natural methods. Vasectomy is a permanent/irreversible method."

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Q22. Johnson's method of counting fetal weight

• a) Fundus height × abdominal circumference
• b) (Fundus height + abdominal circumference) ÷ 4
• c) (Mother's height + mother's weight) × 0.05
• d) Not any of the above

DC Dutta's Obstetrics: "Johnson's formula for estimated fetal weight: Weight in grams = (Fundal height in cm - 11) × 155 (head not engaged) or (Fundal height - 12) × 155 (head engaged)."

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Q23. In threatened abortion, the cervix is

DC Dutta's Obstetrics: "Threatened abortion: Vaginal bleeding in early pregnancy with closed cervical os and viable fetus on ultrasound." Williams Obstetrics: "Threatened abortion: uterine bleeding, closed cervical os, viable intrauterine pregnancy."

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Q24. Stress test for pregnant mothers uses

• Physical exercise and Leopold maneuver are NOT stress tests
• Oestrogen is not used for this test

DC Dutta's Obstetrics: "Oxytocin challenge test (stress test): Dilute IV oxytocin is infused to produce 3 contractions in 10 minutes; fetal heart rate response is monitored. Positive test (late decelerations) indicates fetal compromise." Williams Obstetrics: "The contraction stress test uses oxytocin stimulation to produce uterine contractions and evaluate fetal response."

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Q25. Deceleration in cardiotocogram is

• Normal fetal heart rate baseline: 110-160 bpm
• Deceleration: a transient decrease in FHR below the baseline by ≥15 bpm for ≥15 seconds
• Bradycardia: baseline FHR below 110 bpm

DC Dutta's Obstetrics: "Normal fetal heart rate: 120-160 bpm. Deceleration: transient fall in FHR below 120 bpm (or below baseline by >15 bpm)."

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Q26. Acceleration in cardiotocogram is

• Normal baseline FHR: 110-160 bpm
• Acceleration: transient increase in FHR above the baseline by ≥15 bpm for ≥15 seconds
• Accelerations are a reassuring sign of fetal well-being

DC Dutta's Obstetrics: "Baseline FHR: 120-160 bpm. Accelerations are rises above the baseline; in some classifications, >150 bpm with reactive pattern indicates fetal wellbeing."

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Q27. When is the best time to determine gestation with ultrasound?

• Crown-rump length (CRL) at 7-13 weeks: accuracy ±3-5 days
• Second trimester BPD/FL: accuracy ±1-2 weeks
• Third trimester: accuracy ±2-3 weeks (least accurate)

DC Dutta's Obstetrics: "First trimester ultrasound with CRL measurement is the most accurate method for gestational age determination (±5 days accuracy)." Williams Obstetrics: "Crown-rump length measurement in the first trimester is the most accurate method of gestational age estimation."

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Q28. Find the mistake - Causes of breech presentation

• Prematurity/Premature pregnancy ✓ - most common (fetus hasn't yet settled into vertex)
• Hydrocephaly ✓ - large head cannot enter pelvis; fetus lies breech
• Multiple pregnancy ✓ - restricted space, abnormal lie more common
• Contracted pelvis ✓ - narrow pelvis makes vertex engagement difficult
• Placenta praevia, polyhydramnios, uterine abnormalities

DC Dutta's Obstetrics: "Causes of breech: prematurity (most common), extended legs, hydrocephalus, anencephaly, multiple pregnancy, placenta praevia, contracted pelvis, uterine anomalies. Primigravida is NOT a cause."

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Q29. Point of fixation of baby in breech position

• For the trunk/buttocks: the anterior hip/iliac crest acts as the fulcrum
• The bitrochanteric diameter (between the two greater trochanters = 9.5 cm) is the engaging diameter

DC Dutta's Obstetrics: "In breech delivery, the anterior trochanter (greater trochanter) acts as the point of fixation (hypomochlion) against the pubic arch."

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Q30. Which shoulder is taken out first in normal vaginal vertex delivery?

1. The anterior shoulder is delivered first - by gentle downward traction on the head, the anterior shoulder passes under the pubic symphysis
2. Then the posterior shoulder is delivered by upward traction

DC Dutta's Obstetrics: "After external rotation, the anterior shoulder is delivered by gentle downward traction until it appears under the symphysis pubis. The posterior shoulder then follows." Williams Obstetrics: "Delivery of the shoulders: anterior shoulder delivers first beneath the pubic symphysis, followed by the posterior shoulder."

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Complete Summary Answer Sheet

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• DC Dutta's Textbook of Obstetrics, 9th ed.
• DC Dutta's Textbook of Gynecology, 7th ed.
• Williams Obstetrics, 25th ed. (Cunningham et al.)
• Creasy & Resnik's Maternal-Fetal Medicine, 8th ed.
• Rosen's Emergency Medicine, 9th ed.
• Costanzo Physiology, 7th ed.
• General Anatomy & Musculoskeletal System (Thieme Atlas)