OBG MCQs for NEET PG
918 worked OBG questions across 99 areas. Each one has its own page with the reasoning for every option.
What this set is
Obstetrics and Gynaecology is a large, high-yield subject. Obstetrics is about normal pregnancy, complications and emergencies; gynaecology covers menstrual disorders, infertility, oncology and contraception.
This page lists the 918 OBG questions that have a full worked page: 706 application questions that put a fact to use on a patient or a finding, and 212 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The OBG practice bank in the app is larger, with 3,647 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed OBG test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What OBG covers in the exam
- Normal pregnancy and antenatal care
- Complications of pregnancy
- Labour and delivery
- Postpartum haemorrhage and emergencies
- Hypertensive disorders
- Gynaecological endocrinology
- Infertility and contraception
- Gynaecological oncology
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the OBG study guide.
Worked questions by area
99 areas, largest first. Open an area to see its questions.
Gynaecological oncology87
- Gynaecological oncology · Multi-stepA 16-year-old girl has a rapidly growing pelvic mass. Imaging shows a solid ovarian tumour and the serum AFP level is markedly raised. What is the most likely tumour?
- Gynaecological oncology · ApplicationA 48-year-old woman with Lynch syndrome (MSH2 mutation) has abnormal uterine bleeding. Which statement about her cancer risk is correct?
- Gynaecological oncology: cervical cancer · ApplicationA 48-year-old woman has a biopsy-proven squamous carcinoma of the cervix with parametrial extension that stops short of the pelvic side wall, without distant spread. Wh…
- Gynaecological oncology: cervical screening · ApplicationUnder the Indian national programme for prevention and control of NCDs, what is the recommended screening for cervical cancer in women aged 30 to 65 years?
- Gynaecological oncology: cervical intraepithelial neoplasia · ApplicationA woman has CIN 3 confined to the ectocervix on colposcopic biopsy, with the entire lesion visible. What is the appropriate treatment?
- Gynaecological oncology: cervical cancer staging · ApplicationA woman has a cervical cancer extending to the upper two-thirds of the vagina and into the parametrium without reaching the pelvic wall (FIGO IIB). What is the treatmen…
- Gynaecological oncology: radical hysterectomy · ApplicationDuring hysterectomy, the ureter is most vulnerable to injury at which site?
- Gynaecological oncology: Lynch syndrome · ApplicationA woman with a family history of colorectal cancer develops endometrial carcinoma at 42 years. Which syndrome should be suspected?
- Gynaecological oncology: endometrial hyperplasia · ApplicationWhich type of endometrial hyperplasia has the highest risk of progression to carcinoma?
- Gynaecological oncology: tamoxifen · ApplicationA woman on long-term tamoxifen for breast cancer develops postmenopausal bleeding. Which gynaecological risk is increased by tamoxifen?
- Gynaecological oncology: dysgerminoma · ApplicationA 20-year-old woman has a solid ovarian mass with raised LDH and normal AFP and beta hCG. Histology shows large cells with clear cytoplasm and lymphocytic infiltration.…
- Gynaecological oncology: yolk sac tumour · ApplicationSchiller-Duval bodies are characteristic of which ovarian tumour?
- Gynaecological oncology: granulosa cell tumour · ApplicationA postmenopausal woman has bleeding, an ovarian mass and endometrial hyperplasia. Histology shows Call-Exner bodies. Which marker is useful for follow-up?
- Gynaecological oncology: Sertoli-Leydig tumour · ApplicationA young woman has amenorrhoea, deepening of voice, clitoromegaly and a unilateral ovarian mass. Which tumour is most likely?
- Gynaecological oncology: Meigs syndrome · ApplicationWhich triad defines Meigs syndrome?
- Gynaecological oncology: ovarian cancer risk assessment · Multi-stepThe Risk of Malignancy Index (RMI) for an adnexal mass combines which parameters?
- Gynaecological oncology: BRCA mutation · Multi-stepA 40-year-old woman with a BRCA1 mutation has completed her family. What is the recommended risk-reducing strategy for ovarian cancer?
- Gynaecological oncology: ovarian torsion · ApplicationA young woman has sudden onset severe unilateral pelvic pain with vomiting and a 7 cm adnexal mass. What is the management?
- Gynaecological oncology: ovarian cancer treatment · ApplicationThe standard adjuvant chemotherapy for epithelial ovarian cancer after debulking surgery is:
- Gynaecological oncology: vulval disease · ApplicationA postmenopausal woman has intensely itchy, white atrophic, parchment-like vulval skin with loss of labia minora. What is the first-line treatment?
- Gynaecological oncology: vulval cancer · ApplicationIn vulval carcinoma, which lymph nodes are the first to be involved?
- Gynaecological oncology: vaginal clear cell carcinoma · ApplicationIn-utero exposure to which drug is associated with clear cell adenocarcinoma of the vagina?
- Gynaecological oncology: hydatidiform follow-up contraception · ApplicationWhich contraceptive method is preferred while monitoring hCG after a molar pregnancy until levels normalise?
- Gynaecological oncology: vulval Paget disease · Multi-stepA 68-year-old woman has a long-standing pruritic, red, well-demarcated eczematous plaque with white islands on the vulva that has not responded to steroid creams. Biops…
- Gynaecological oncology: radical trachelectomy · ApplicationA 28-year-old nulliparous woman has a 1.5 cm squamous carcinoma of the cervix confined to the cervix, with negative pelvic nodes on imaging, and wishes to preserve fert…
- Gynaecological oncology: brachytherapy points · ApplicationIn the Manchester system for intracavitary radiotherapy in cervical cancer, where is point A located?
- Gynaecological oncology: serous endometrial carcinoma · ApplicationA 72-year-old thin woman has postmenopausal bleeding, and biopsy shows high-grade serous endometrial carcinoma with strong p53 staining. Which statement describes this…
- Gynaecological oncology: leiomyosarcoma · Multi-stepA 58-year-old postmenopausal woman has a pelvic mass that has enlarged rapidly over 3 months with bleeding. MRI shows a heterogeneous mass with central necrosis and irr…
- Gynaecological oncology: sarcoma botryoides · ApplicationA 2-year-old girl has bloody vaginal discharge, and examination shows a polypoid grape-like mass protruding from the vagina. Biopsy shows small round cells positive for…
- Gynaecological oncology: Latzko triad · ApplicationA 55-year-old postmenopausal woman has intermittent profuse watery vaginal discharge, colicky lower abdominal pain relieved after the discharge, and a palpable adnexal…
- Gynaecological oncology: uterine carcinosarcoma · Multi-stepA 70-year-old woman who had pelvic radiotherapy for rectal cancer years ago presents with postmenopausal bleeding and a polypoid uterine mass. Histology shows malignant…
- Gynaecological oncology: immature teratoma · Multi-stepA 14-year-old girl has a 20 cm solid-cystic ovarian mass. Histology after unilateral oophorectomy shows immature neural tissue graded as grade 3, and the tumour extends…
- Gynaecological oncology: vulval intraepithelial neoplasia · ApplicationA 30-year-old smoker has multiple pigmented raised vulval lesions, and biopsy shows high-grade squamous intraepithelial lesion (usual type VIN) associated with HPV 16.…
- Gynaecological oncology: atypical glandular cells · Multi-stepA 41-year-old woman has a cervical cytology report of atypical glandular cells. What is the appropriate evaluation?
- Gynaecological oncology: HE4 · ApplicationA premenopausal woman has a pelvic mass with CA-125 of 120 U/mL. Which additional marker helps to distinguish a malignant epithelial tumour from endometriosis, as it is…
- Gynaecological oncology: borderline ovarian tumour · Multi-stepA 26-year-old nulligravida has a unilateral serous borderline tumour confined to one ovary, with no peritoneal implants after surgical staging, and wishes to conceive.…
- Gynaecological oncology: endometrial stromal sarcoma · ApplicationA 45-year-old woman has hysterectomy for a presumed fibroid, and histology shows low-grade endometrial stromal sarcoma with tongue-like myometrial invasion, positive fo…
- Gynaecological oncology: FIGO 2018 stage IB3 · Multi-stepA 40-year-old woman has a 4.5 cm squamous cervical carcinoma confined to the cervix, without parametrial extension or nodal spread on imaging. What is the FIGO 2018 sta…
- Gynaecological oncology: FIGO 2018 nodal staging · Multi-stepA 2 cm cervical carcinoma confined to the cervix is found to have a metastatic pelvic lymph node on imaging. According to FIGO 2018, how is it staged?
- Gynaecological oncology: CIN in pregnancy · Multi-stepA 26-year-old at 14 weeks has a cytology report of high-grade squamous intraepithelial lesion, and colposcopy shows no features of invasion. What is the best plan?
- Gynaecological oncology: screening after hysterectomy · ApplicationA 55-year-old woman has had a total hysterectomy for fibroids with a normal cervix, and no previous history of CIN 2 or worse. What is the recommendation for cervical s…
- Gynaecological oncology: myometrial invasion in endometrial cancer · ApplicationA woman has an endometrioid endometrial carcinoma that invades less than half of the myometrium and has no cervical or adnexal involvement. What is its FIGO 2009 stage?
- Gynaecological oncology: CA-125 use · ApplicationIn ovarian cancer, what is the most valuable role of serum CA-125?
- Gynaecological oncology: mucinous ovarian tumour · Multi-stepA 40-year-old woman has bilateral mucinous ovarian masses, each about 8 cm, with raised CEA and CA 19-9 and a normal CA-125. What is the most appropriate evaluation?
- Gynaecological oncology: vaginal cancer · ApplicationWhich statement about carcinoma of the vagina is correct?
- Gynaecological oncology: HSIL management · Multi-stepA 32-year-old non-pregnant woman has high-grade squamous intraepithelial lesion on cytology, and colposcopy shows a type 1 transformation zone with a high-grade lesion.…
- Gynaecological oncology: HIV and cervical disease · ApplicationWhy are women living with HIV advised more frequent cervical screening?
- Gynaecological oncology: eligibility for ablative treatment · Multi-stepUnder a screen-and-treat programme, VIA is positive in a 38-year-old woman. Which finding makes her eligible for cryotherapy or thermal ablation?
- Gynaecological oncology: neoadjuvant chemotherapy · ApplicationA 62-year-old with advanced stage IIIC ovarian cancer and poor performance status has extensive disease in the upper abdomen, and primary cytoreduction is judged unlike…
- Gynaecological oncology: platinum sensitivity · Multi-stepA woman with ovarian cancer completed carboplatin-paclitaxel 10 months ago and now has a rising CA-125 with a pelvic recurrence on imaging. How is her disease classified?
- Gynaecological oncology: adjuvant radiotherapy after radical hysterectomy · Multi-stepAfter radical hysterectomy for early-stage cervical cancer, histology shows negative nodes and margins but deep stromal invasion, lymphovascular space invasion and tumo…
- Gynaecological oncology: pelvic exenteration · Multi-stepA woman 18 months after chemoradiation for cervical cancer has a central pelvic recurrence involving the bladder and vagina, with no pelvic side wall involvement or dis…
- Gynaecological oncology: radical hysterectomy classification · ApplicationIn the Querleu-Morrow classification of radical hysterectomy, which class corresponds to the classical Piver class III operation with complete resection of the parametr…
- Gynaecological oncology: simple cyst in postmenopausal woman · ApplicationA 60-year-old woman has an incidental 3 cm unilocular anechoic ovarian cyst with no solid components or flow, and a normal CA-125. What is the best management?
- Gynaecological oncology: sarcoma risk factors · ApplicationWhich of the following is a recognised risk factor for uterine sarcoma and carcinosarcoma?
- Gynaecological oncology: radiation fistula · Multi-stepA woman 8 months after pelvic radiotherapy for cervical cancer develops continuous urinary leakage, and cystoscopy shows a vesicovaginal fistula with indurated tissue.…
- Gynaecological oncology: hormone therapy after cervical cancer · ApplicationA 38-year-old woman who underwent chemoradiation for squamous cervical cancer has premature ovarian failure with severe menopausal symptoms and bone loss. What is the a…
- Gynaecological oncology: colposcopic features · ApplicationAt colposcopy, which finding most strongly suggests a high-grade cervical lesion?
- Gynaecological oncology: stage IVA cervical cancer · ApplicationA woman with locally advanced cervical cancer has haematuria. What is required to diagnose bladder mucosal invasion (stage IVA)?
- Gynaecological oncology: CA-125 to CEA ratio · Multi-stepA 55-year-old woman has ascites and a pelvic mass. CA-125 is 900 U/mL and CEA is 4 ng/mL. What does the CA-125 to CEA ratio suggest?
- Gynaecological oncology: follow-up after treatment · ApplicationWhen do most recurrences of cervical cancer after primary treatment occur?
- Gynaecological oncology: HRT after risk-reducing oophorectomy · Multi-stepA 40-year-old BRCA2 carrier without breast cancer has risk-reducing salpingo-oophorectomy with her uterus preserved and has severe vasomotor symptoms. What is the advice?
- Gynaecological oncology: groin dissection complications · ApplicationA woman undergoes radical vulvectomy with bilateral inguinofemoral lymphadenectomy for vulval cancer. Which complication is most common?
- Gynaecological oncology: clear cell ovarian carcinoma · ApplicationA 48-year-old woman with a long history of endometriosis has a 10 cm unilocular ovarian cyst with a solid mural nodule, and histology shows clear cell carcinoma. Which…
- Gynaecological oncology: ASCUS with HPV triage · ApplicationA 35-year-old woman has a Pap smear reported as atypical squamous cells of undetermined significance. Reflex high-risk HPV testing is positive. What is the next step?
- Gynaecological oncology: sex cord stromal tumours · ApplicationA 55-year-old woman has postmenopausal bleeding and an adnexal mass. Histology shows coffee-bean nuclei with Call-Exner bodies. What is the tumour?
- Gynaecological oncology: germ cell tumours · Multi-stepA 35-year-old woman with a dermoid cyst of the ovary has weight loss, tremor and a suppressed TSH. Which tumour component produces her symptoms?
- Gynaecological oncology: cervical screening · ApplicationDuring colposcopy, an area of the cervix does not take up iodine and stays pale yellow after Lugol's application. What explains this?
- Gynaecological oncology: Brenner tumour · ApplicationA 60-year-old woman has a solid unilateral ovarian mass that looks like a fibroma. Histology shows nests of urothelium-like epithelium set in dense fibrous stroma. What…
- Gynaecological oncology: node of Cloquet · ApplicationIn vulval cancer, the node of Cloquet is the highest deep inguinal node. Where does it lie?
- Gynaecological oncology: bladder dysfunction after radical hysterectomy · ApplicationAfter a Wertheim radical hysterectomy, a woman cannot sense bladder filling and has difficulty voiding. What is the cause?
- Gynaecological oncology: uterine artery embolisation · ApplicationA 40-year-old with symptomatic 6 cm fibroids has completed her family and wishes to avoid hysterectomy. Which minimally invasive treatment obliterates the blood supply…
- Gynaecological oncology: fertility-sparing treatment in endometrial cancer · Multi-stepA 30-year-old nulliparous woman with PCOS has grade 1 endometrioid adenocarcinoma on biopsy. MRI shows no myometrial invasion and no extrauterine disease, and she stron…
- Gynaecological oncology: FIGO staging with hydronephrosis · ApplicationA woman has cervical carcinoma limited to the cervix and upper vagina on examination, but imaging shows unilateral hydronephrosis from ureteric obstruction by tumour. W…
- Gynaecological oncology: molecular features of type I endometrial cancer · ApplicationWhich molecular alteration is most typical of endometrioid (type I) endometrial carcinoma?
- Gynaecological oncology: sentinel node biopsy in vulval cancer · Multi-stepA woman has a unifocal 2 cm squamous carcinoma of the vulva with clinically normal groins. What is the advantage of sentinel node biopsy over full inguinofemoral lympha…
- Gynaecological oncology: PARP inhibitor mechanism · ApplicationIn a woman with BRCA-mutated high-grade serous ovarian cancer responding to platinum chemotherapy, maintenance olaparib acts by which mechanism?
- Gynaecological oncology: ovarian transposition · ApplicationA 28-year-old with cervical cancer is to receive pelvic radiotherapy and wishes to preserve ovarian endocrine function. Which procedure can be done before radiation?
- Gynaecological oncology: ovarian cancer screening · ApplicationWhich statement about screening for ovarian cancer in average-risk asymptomatic women is correct?
- Gynaecological oncology: pseudomyxoma peritonei · Multi-stepA woman has gelatinous mucinous ascites and peritoneal deposits with a mucinous ovarian mass. Which organ should be examined as a possible primary source?
- Gynaecological oncology: lymphocele after pelvic lymphadenectomy · ApplicationThree weeks after radical hysterectomy with pelvic lymphadenectomy, a woman has a cystic pelvic collection of clear straw-coloured fluid whose creatinine matches serum.…
- Gynaecological oncology: FIGO ovarian stage IC1 · Multi-stepDuring removal of an apparently stage IA ovarian serous tumour, the capsule ruptures and fluid spills into the pelvis. No other disease is found. What is the FIGO stage?
- Gynaecological oncology: Peutz-Jeghers syndrome · Multi-stepWhich pair of gynaecological tumours is associated with Peutz-Jeghers syndrome?
- Gynaecological oncology: screening after HPV vaccination · ApplicationA 24-year-old who received a bivalent HPV vaccine at age 14 asks whether she can skip cervical screening. What is the advice?
- Gynaecological oncology: obstetric effect of excisional cervical treatment · ApplicationA woman had a large cone excision for CIN 3 and now plans pregnancy. Which complication is increased?
- Gynaecological oncology: malignant transformation in dermoid cyst · ApplicationWhich is the commonest malignancy arising in a mature cystic teratoma of the ovary?
- Gynaecological oncology: surgery for early endometrial cancer · ApplicationA 58-year-old woman has grade 1 endometrioid carcinoma confined to the uterus on MRI. What is the standard surgery?
Hypertensive disorders61
- Hypertensive disorders: HELLP · ApplicationWhich set of findings defines HELLP syndrome?
- Hypertensive disorders: magnesium sulphate regimen · ApplicationAccording to the Indian national (Pritchard) regimen for severe pre-eclampsia, what is the loading dose of magnesium sulphate?
- Hypertensive disorders: magnesium monitoring · Multi-stepAt approximately which serum magnesium concentration does the patellar reflex disappear?
- Hypertensive disorders: monitoring on magnesium · ApplicationBefore administering a repeat maintenance dose of magnesium sulphate, which of the following must be confirmed?
- Hypertensive disorders: antihypertensives · ApplicationWhich antihypertensive is contraindicated in pregnancy?
- Hypertensive disorders: acute severe hypertension · ApplicationWhich regimen is appropriate for acute severe hypertension in pre-eclampsia?
- Hypertensive disorders: prevention · ApplicationWhich agent started before 16 weeks in a woman with high risk for pre-eclampsia reduces its incidence?
- Hypertensive disorders: pathogenesis · ApplicationWhich event is central to the pathogenesis of pre-eclampsia?
- Hypertensive disorders: timing of delivery · Multi-stepIn pre-eclampsia with severe features (stable, no fetal compromise), at what gestation is delivery recommended after maternal stabilisation?
- Hypertensive disorders: biomarkers · Multi-stepA sFlt-1 to PlGF ratio below 38 in a woman with suspected pre-eclampsia is used to:
- Hypertensive disorders: chronic hypertension · ApplicationA woman with chronic hypertension develops new proteinuria and a sudden rise in BP at 30 weeks. What is the diagnosis?
- Hypertensive disorders: HELLP steroids · Multi-stepIn a woman with HELLP syndrome at 30 weeks, antenatal corticosteroids are given primarily to:
- Hypertensive disorders: Zuspan regimen · ApplicationWhich of the following correctly describes the Zuspan regimen of magnesium sulphate for eclampsia?
- Hypertensive disorders: postpartum pre-eclampsia · Multi-stepA woman who had a normal vaginal delivery 5 days ago after an uncomplicated pregnancy presents with a severe headache and blood pressure 168/112 mmHg, with 3+ proteinur…
- Hypertensive disorders: protein-creatinine ratio · ApplicationA 28-week pregnant woman has a blood pressure of 150/96 mmHg on two occasions and a spot urine protein-to-creatinine ratio of 0.35 mg/mg. How is this interpreted?
- Hypertensive disorders: posterior reversible encephalopathy · Multi-stepA woman with severe pre-eclampsia has a seizure, followed by headache, visual blurring and confusion. MRI shows bilateral parieto-occipital hyperintensities on FLAIR se…
- Hypertensive disorders: eclamptic seizure management · Multi-stepA woman at 35 weeks with severe pre-eclampsia has a seizure on the ward. It stops after 90 seconds. After securing the airway, what should be done next?
- Hypertensive disorders: HELLP syndrome · ApplicationA woman at 35 weeks with epigastric pain has haemolysis, raised liver enzymes and low platelets. What is the definitive treatment?
- Hypertensive disorders: pathogenesis · ApplicationWhich angiogenic imbalance is found in the maternal circulation in pre-eclampsia?
- Hypertensive disorders: antihypertensive choice · Multi-stepWhich drug used in hypertensive emergencies is avoided in pregnancy except as a last resort because its metabolites cross the placenta and harm the fetus?
- Hypertensive disorders · ApplicationA primigravida at 35 weeks has BP 148/96 mmHg on two readings four hours apart. She has no proteinuria, headache or visual symptoms, and laboratory tests are normal. Wh…
- Hypertensive disorders: mechanism of aspirin prophylaxis · ApplicationLow-dose aspirin reduces the risk of pre-eclampsia in high-risk women. Which mechanism explains this?
- Hypertensive disorders: methyldopa haemolysis · ApplicationA pregnant woman on methyldopa for chronic hypertension becomes tired, pale and mildly jaundiced. The direct Coombs test is positive. What is the best explanation?
- Hypertensive disorders: hydralazine adverse effects · ApplicationA woman with pre-eclampsia given intravenous hydralazine for severe hypertension develops palpitations, headache and flushing. What explains these effects?
- Hypertensive disorders: atenolol and fetal growth · ApplicationProlonged use of which antihypertensive from early pregnancy has been linked with fetal growth restriction?
- Hypertensive disorders: diuretic indication · ApplicationIn which situation in severe pre-eclampsia is furosemide an accepted treatment?
- Hypertensive disorders: fluid restriction · ApplicationWhy is the total intravenous fluid intake restricted in severe pre-eclampsia?
- Hypertensive disorders: magnesium in renal impairment · Multi-stepA woman with eclampsia has received a 4 g intravenous loading dose of magnesium sulphate. Her urine output is 15 mL per hour and serum creatinine is raised. How should…
- Hypertensive disorders: recurrent seizure on magnesium · ApplicationA woman on maintenance magnesium sulphate for eclampsia has a second convulsion. Reflexes are present and respiration is normal. What is the next step?
- Hypertensive disorders: indications for neuroimaging in eclampsia · ApplicationWhich feature in a woman with eclampsia most strongly suggests the need for brain imaging?
- Hypertensive disorders: fetal bradycardia after seizure · ApplicationA woman at 34 weeks has an eclamptic seizure. The CTG shows fetal bradycardia that is recovering as she stabilises. What is the best approach?
- Hypertensive disorders: mode of delivery in eclampsia · ApplicationA woman with eclampsia at 38 weeks is stable after magnesium sulphate and blood pressure control, and the cervix is favourable. Which statement about delivery is correct?
- Hypertensive disorders: indication for delivery despite prematurity · Multi-stepA woman with severe pre-eclampsia at 31 weeks is under expectant management on a high-dependency unit. Which new finding mandates delivery after stabilisation regardles…
- Hypertensive disorders: angiotensin II sensitivity · ApplicationNormal pregnant women resist the pressor effect of infused angiotensin II. What happens in women who go on to develop pre-eclampsia?
- Hypertensive disorders: renal histology · Multi-stepA renal biopsy in a woman with pre-eclampsia shows enlarged glomeruli with bloodless capillary loops. Which finding is characteristic?
- Hypertensive disorders: placental bed histology · ApplicationExamination of the placental bed in severe pre-eclampsia would typically show which vascular finding?
- Hypertensive disorders: haemodynamic profile · ApplicationHow does the plasma volume in established pre-eclampsia compare with that of a normal pregnancy?
- Hypertensive disorders: early-onset pre-eclampsia · ApplicationWhich feature is more typical of early-onset pre-eclampsia (before 34 weeks) than of late-onset disease?
- Hypertensive disorders: who should receive aspirin · ApplicationWhich woman should be offered low-dose aspirin prophylaxis from early in pregnancy?
- Hypertensive disorders: pre-eclampsia before 20 weeks · ApplicationA woman at 14 weeks has blood pressure 160/110 mmHg, proteinuria, a uterus larger than dates and vomiting. Which underlying condition should be suspected?
- Hypertensive disorders: phaeochromocytoma in pregnancy · Multi-stepA woman at 22 weeks has paroxysmal headache, sweating and palpitations with blood pressure 190/110 mmHg. Urine metanephrines are raised and imaging shows an adrenal mas…
- Hypertensive disorders: antihypertensive in lactation · ApplicationA breastfeeding mother with persistent hypertension after delivery needs long-term therapy. Which drug is acceptable?
- Hypertensive disorders: anaesthesia for caesarean · Multi-stepA woman with severe pre-eclampsia needs a caesarean section. Platelet count is 150,000 per microlitre and coagulation is normal. Which technique is preferred?
- Hypertensive disorders: HELLP blood film · ApplicationA pregnant woman with right upper quadrant pain has anaemia, raised LDH and a low platelet count. Which peripheral smear finding supports HELLP syndrome?
- Hypertensive disorders: TTP versus HELLP · Multi-stepA woman at 24 weeks has fever, confusion, severe thrombocytopenia, haemolysis with schistocytes and rising creatinine. BP is normal, the coagulation screen is normal an…
- Hypertensive disorders: hepatic haematoma in HELLP · Multi-stepA woman with HELLP syndrome, delivered yesterday, develops sudden severe right upper abdominal pain radiating to the right shoulder, with hypotension and a distended ab…
- Hypertensive disorders: epigastric pain mechanism · ApplicationWhat is the mechanism of epigastric or right upper quadrant pain in severe pre-eclampsia?
- Hypertensive disorders: pulmonary oedema management · ApplicationA woman with severe pre-eclampsia becomes breathless after intravenous fluids, with bibasal crepitations and SpO2 of 88 per cent. What are the first measures?
- Hypertensive disorders: avoiding abrupt fall in pressure · ApplicationWhy should blood pressure in severe pre-eclampsia be lowered gradually, not precipitously?
- Hypertensive disorders: choice of drug in asthma · Multi-stepA woman at 33 weeks with bronchial asthma has a blood pressure of 168/112 mmHg and needs urgent oral treatment. Which choice is better?
- Hypertensive disorders: neonate after maternal magnesium · ApplicationA baby delivered after the mother received magnesium sulphate for 24 hours for severe pre-eclampsia is floppy with depressed respiration. Which explanation is most like…
- Hypertensive disorders: change of partner and risk · ApplicationA multiparous woman who had a normal first pregnancy develops pre-eclampsia in a first pregnancy with a new partner. Which concept explains her increased risk?
- Hypertensive disorders · ApplicationWhat new finding distinguishes preeclampsia from uncomplicated gestational hypertension?
- Hypertensive disorders · ApplicationWhat medication is used to prevent seizures in severe preeclampsia?
- Hypertensive disorders · ApplicationWhat blood-pressure disorder develops after mid-pregnancy without proteinuria or end-organ dysfunction?
- Hypertensive disorders · ApplicationA pregnant patient with preeclampsia develops an otherwise unexplained generalized seizure; what complication has occurred?
- Hypertensive disorders · ApplicationWhat medication prevents seizures in severe preeclampsia?
- Hypertensive disorders · ApplicationWhat new symptom warrants urgent review in preeclampsia?
- Hypertensive disorders · ApplicationWhich feature makes preeclampsia more likely after 20 weeks' gestation?
- Hypertensive disorders · ApplicationWhat medication is used to prevent seizures in severe preeclampsia or eclampsia?
- Hypertensive disorders · ApplicationWhat finding defines proteinuria in suspected pre-eclampsia most directly?
Antenatal care53
- Antenatal care · ApplicationA woman's last menstrual period began on 10 January 2026. Using Naegele's rule, what is her expected date of delivery?
- Antenatal care · ApplicationA woman at 24 weeks has pallor, haemoglobin of 9 g/dL and a microcytic hypochromic smear. She is clinically stable and tolerates oral medication. What is the most appro…
- Antenatal care · Multi-stepA 26-week monochorionic diamniotic twin pregnancy shows one twin with oligohydramnios (maximum vertical pocket under 2 cm) and a small bladder, and the other with polyh…
- Antenatal care · ApplicationA pregnant woman at her booking visit has a positive VDRL and confirmatory treponemal test, and no history of penicillin allergy. What is the appropriate treatment?
- Antenatal care · ApplicationA woman at 18 weeks gestation with a known 7 cm uterine fibroid presents with severe focal abdominal pain, low-grade fever and localised uterine tenderness. Ultrasound…
- Antenatal care: gestational diabetes · ApplicationIn India, a single-step test for gestational diabetes can be done at the first antenatal visit irrespective of the time of the last meal, using a 75 g oral glucose load…
- Antenatal care: malpresentation · ApplicationA 28-year-old primigravida at 37 weeks has a confirmed breech presentation with a normal ultrasound, normal liquor volume and an anterior, fundal placenta. Which is the…
- Antenatal care: preterm prelabour rupture of membranes · ApplicationA woman at 30 weeks has a gush of clear fluid from the vagina. Speculum examination confirms pooling of liquor. She has no contractions, no fever, and the fetal heart r…
- Antenatal care: amniotic fluid disorders · Multi-stepA 32-year-old woman at 34 weeks has a uterus larger than dates, a tense abdomen and an amniotic fluid index of 30 cm. Ultrasound shows no stomach bubble in the fetus. W…
- Antenatal care: cholestasis · ApplicationA woman at 33 weeks has severe itching of the palms and soles, worse at night, without a rash. Serum bile acids are 45 micromol/L and transaminases are mildly raised. W…
- Antenatal care: iron and folic acid · ApplicationUnder the national Anaemia Mukt Bharat strategy, what is the standard daily iron-folic acid supplementation for a pregnant woman without anaemia?
- Antenatal care: tetanus immunisation · ApplicationA primigravida with no previous immunisation attends at 14 weeks. According to the Indian programme, which regimen is correct?
- Antenatal care: aneuploidy screening · ApplicationWhich combination on the second-trimester quadruple test is most suggestive of Down syndrome?
- Antenatal care: first trimester screening · ApplicationA 38-year-old woman at 12 weeks has a nuchal translucency of 4.2 mm. Which additional biochemical finding would support trisomy 21?
- Antenatal care: invasive prenatal diagnosis · ApplicationWhich statement about chorionic villus sampling (CVS) is correct?
- Antenatal care: intravenous iron · ApplicationA woman at 26 weeks with Hb 8 g/dL has not responded to oral iron. Which statement about intravenous iron in pregnancy is correct?
- Antenatal care: dating ultrasound · ApplicationWhich ultrasound parameter is the most accurate for dating a pregnancy in the first trimester?
- Antenatal care: immunisation · ApplicationWhich vaccine is recommended in every pregnancy at 27 to 36 weeks in many national guidelines to protect the newborn from pertussis?
- Antenatal care: fetal lung maturity · ApplicationWhich finding in amniotic fluid indicates fetal lung maturity?
- Antenatal care: antenatal corticosteroids · ApplicationA woman at 30 weeks has threatened preterm labour. Which regimen of antenatal corticosteroids is standard?
- Antenatal care: non-stress test · ApplicationWhich finding defines a reactive non-stress test?
- Antenatal care: biophysical profile · ApplicationWhich of the following is NOT a component of the biophysical profile?
- Antenatal care: Doppler in fetal anaemia · Multi-stepIn a pregnancy with Rh alloimmunisation, which Doppler measurement is used to non-invasively predict moderate to severe fetal anaemia?
- Antenatal care: umbilical artery Doppler · Multi-stepIn a growth-restricted fetus, which umbilical artery Doppler finding carries the worst prognosis?
- Antenatal care: pre-gestational diabetes · ApplicationWhich congenital anomaly is most specific for maternal pre-gestational diabetes?
- Antenatal care: nutrition and calcium · ApplicationTo reduce the risk of pre-eclampsia in women with low dietary calcium intake, which supplementation is recommended by WHO?
- Antenatal care: uterine artery Doppler · Multi-stepPersistent bilateral uterine artery notching at 20 to 24 weeks is a marker for:
- Antenatal care: Potter sequence · ApplicationA newborn has a flattened face with low-set ears, a beaked nose, limb deformities and severe respiratory distress. The antenatal scans showed severe oligohydramnios. Wh…
- Antenatal care: contraction stress test · ApplicationA contraction stress test in a woman at 36 weeks with suspected growth restriction shows late decelerations after more than half of three contractions in 10 minutes. Ho…
- Antenatal care: non-immune hydrops · ApplicationA fetal ultrasound shows ascites, pleural effusion and skin oedema, and the mother is Rh positive with a negative indirect Coombs test. What is the commonest category o…
- Antenatal care: congenital diaphragmatic hernia on anomaly scan · Multi-stepAt the 20-week anomaly scan the fetal stomach bubble is seen in the thorax at the level of the four-chamber view, the heart is displaced to the right and the abdominal…
- Antenatal care: intimate partner violence · ApplicationA pregnant woman attends antenatal clinic accompanied by her husband, who insists on staying with her. She has unexplained bruises and missed several visits. What is th…
- Antenatal care: symmetric versus asymmetric fetal growth restriction · ApplicationA fetus at 32 weeks shows head circumference, abdominal circumference and femur length all below the 3rd centile with normal liquor and umbilical Doppler. Which cause i…
- Antenatal care: pregnancy after bariatric surgery · ApplicationA woman who had a Roux-en-Y gastric bypass 8 months ago wishes to conceive. What advice is most appropriate?
- Antenatal care: fetal and neonatal alloimmune thrombocytopenia · Multi-stepA healthy primigravida has normal platelet counts, but her newborn has a platelet count of 12,000 per microlitre with intracranial haemorrhage. Maternal antibodies agai…
- Antenatal care · ApplicationWhat is a key purpose of antenatal blood-pressure monitoring?
- Antenatal care · ApplicationWhich vaccine-preventable infection screening is important in pregnancy?
- Antenatal care · ApplicationWhat supplement is routinely used before and during early pregnancy to reduce neural tube defects?
- Antenatal care · ApplicationWhat is routinely measured at antenatal visits to screen for hypertensive disease?
- Antenatal care · ApplicationWhat fundal measurement is commonly used to follow fetal growth after mid-pregnancy?
- Antenatal care · ApplicationWhy is a dating ultrasound useful early in pregnancy?
- Antenatal care · ApplicationWhat nutritional issue is commonly monitored during pregnancy?
- Antenatal care · ApplicationWhat supplement reduces neural-tube-defect risk when started before conception?
- Antenatal care · ApplicationWhat ultrasound measurement is most accurate for early pregnancy dating?
- Antenatal care · ApplicationWhy is folic acid advised before conception and in early pregnancy?
- Antenatal care · ApplicationWhich supplement reduces neural tube defect risk when started before conception?
- Antenatal care · ApplicationWhich symptom in pregnancy requires urgent assessment for possible pre-eclampsia?
- Antenatal care: hypertension · Multi-stepAt 33 weeks, a patient has blood pressure 168/112 mmHg, headache, visual disturbance, and proteinuria. Which medication is used to prevent eclamptic seizures?
- Antenatal care: pre-eclampsia · ApplicationWhich finding distinguishes pre-eclampsia from uncomplicated chronic hypertension in pregnancy?
- Antenatal care: dating · ApplicationWhich ultrasound measurement is most accurate for establishing gestational age in the first trimester?
- Antenatal care: fetal growth restriction · Multi-stepA fetus has estimated weight below the 10th centile, reduced growth velocity, and abnormal umbilical-artery Doppler with absent end-diastolic flow. What is the major co…
- Antenatal care: multiple pregnancy · ApplicationWhy do monochorionic twin pregnancies require closer ultrasound surveillance than dichorionic twins?
- Antenatal care: twin-to-twin transfusion · Multi-stepIn monochorionic diamniotic twins, one twin has oligohydramnios with an empty bladder while the co-twin has polyhydramnios and a distended bladder. What syndrome is lik…
Labour52
- Labour · ApplicationWhat does the Bishop score assess?
- Labour: partograph · ApplicationOn a WHO partograph, a woman in the active phase has cervical dilatation plotted. The action line is drawn how many hours to the right of the alert line, and what does…
- Labour: malpresentation · ApplicationIn which face presentation can a vaginal delivery occur?
- Labour: brow presentation · ApplicationWhich diameter presents in a brow presentation and explains why a term baby cannot deliver vaginally?
- Labour: breech delivery · ApplicationDuring assisted breech delivery, the arms are found extended above the head. Which manoeuvre is used?
- Labour: external cephalic version · ApplicationWhich of the following is an absolute contraindication to external cephalic version for breech presentation?
- Labour: cord prolapse · ApplicationA multiparous woman at 38 weeks has a loop of pulsating cord visible at the vulva after spontaneous rupture of membranes, with the cervix 4 cm dilated. What is the best…
- Labour: uterine rupture · Multi-stepA woman with a previous lower segment caesarean section in spontaneous labour suddenly develops severe abdominal pain, fetal heart rate falls to 70/min and the presenti…
- Labour: obstructed labour · ApplicationA woman with 2 days of labour has a distended bladder, a tender lower abdomen and an oblique groove at the level of the umbilicus. What is this groove called?
- Labour: induction in scarred uterus · ApplicationWhich agent is contraindicated for cervical ripening in a woman with one previous caesarean section?
- Labour: oxytocin · ApplicationWhich complication results from prolonged infusion of oxytocin in a large volume of electrolyte-free fluid?
- Labour: uterine inertia · ApplicationA primigravida in labour has infrequent weak contractions, a cervix stuck at 5 cm, intact membranes and a normal pelvis. What is the next step?
- Labour: perineal tears · ApplicationA woman sustains a perineal tear involving more than 50 per cent thickness of the external anal sphincter. How is it classified?
- Labour: forceps prerequisites · ApplicationWhich of the following is NOT a prerequisite for forceps delivery?
- Labour: vacuum extraction · ApplicationVentouse (vacuum) extraction is contraindicated in which situation?
- Labour: classical caesarean section · ApplicationA woman had a classical caesarean section at 30 weeks for placenta praevia. What is the recommended mode of delivery in her next pregnancy?
- Labour: trial of labour after caesarean · ApplicationWhich woman is the best candidate for vaginal birth after caesarean (VBAC)?
- Labour: sinusoidal pattern · ApplicationA smooth, undulating sinusoidal fetal heart rate pattern is most characteristic of:
- Labour: fetal blood sampling · Multi-stepWhich fetal scalp blood pH is considered abnormal and an indication for urgent delivery?
- Labour: meconium · ApplicationA baby is born through meconium-stained liquor, is limp and not breathing. What is the appropriate initial step according to current neonatal resuscitation guidance?
- Labour: analgesia · ApplicationWhich is the most effective method of pain relief in labour?
- Labour: pudendal nerve block · ApplicationThe pudendal nerve is blocked at which landmark?
- Labour: android pelvis · Multi-stepA fetal head arrests in the mid-pelvis in a transverse position with a converging pelvic sidewall and prominent ischial spines. Which pelvis type is likely?
- Labour: pelvic measurements · ApplicationIf the diagonal conjugate measures 12 cm, the obstetric conjugate is approximately:
- Labour: antenatal magnesium sulphate for neuroprotection · ApplicationIn a woman in preterm labour at 29 weeks, magnesium sulphate given before delivery reduces which neonatal outcome?
- Labour: tocolytics · ApplicationWhich tocolytic acts as an oxytocin receptor antagonist?
- Labour: betamimetic side effects · ApplicationWhich adverse effects are characteristic of ritodrine or terbutaline tocolysis?
- Labour: chorioamnionitis · ApplicationA woman with prolonged rupture of membranes develops fever of 38.5 degrees C, maternal and fetal tachycardia, uterine tenderness and foul liquor. What is the management?
- Labour: occipitoposterior position · ApplicationIn a persistent occipitoposterior position, delivery typically occurs by which mechanism?
- Labour: Ferguson reflex · ApplicationStretching of the cervix and upper vagina leads to increased release of which hormone?
- Labour: amniotic fluid embolism · ApplicationA multiparous woman suddenly develops dyspnoea, cyanosis, hypotension and seizures during labour followed by bleeding from puncture sites. What is the most likely diagn…
- Labour: prolonged latent phase · ApplicationA nulliparous woman has had painful irregular contractions for 24 hours with a cervix that is 2 cm dilated, 50 percent effaced, with intact membranes and a reassuring f…
- Labour: uterine tachysystole · Multi-stepA woman at 40 weeks who had a dinoprostone vaginal insert placed 6 hours ago now has 7 contractions in 10 minutes with recurrent late decelerations. What is the most ap…
- Labour: timing of cord clamping · ApplicationA vigorous term neonate is born vaginally. According to WHO recommendations, when should the umbilical cord be clamped?
- Labour: shoulder dystocia manoeuvres · Multi-stepAt delivery of a macrosomic infant the head retracts against the perineum (turtle sign). McRoberts position and suprapubic pressure have failed. Which next manoeuvre is…
- Labour: Robson classification · ApplicationA labour ward audit uses the Robson ten-group classification. Which patients make up group 1?
- Labour: anaesthesia for caesarean · Multi-stepA woman receiving spinal anaesthesia for a caesarean section becomes nauseous with a fall in blood pressure from 120/70 to 78/40 mmHg. Besides left uterine displacement…
- Labour: symphysiotomy · ApplicationSymphysiotomy is sometimes used in places without surgical facilities. What is its effect?
- Labour: asynclitism · ApplicationDuring labour a vaginal examination shows that the sagittal suture of the fetal head lies closer to the sacral promontory than to the symphysis pubis. What is this call…
- Labour: epidural-associated fever · ApplicationA nulliparous woman with an epidural in labour develops a temperature of 38.2 degrees C, maternal tachycardia, and a normal vaginal discharge, with fetal heart rate bas…
- Labour: post-dural puncture headache · Multi-stepA woman 2 days after a caesarean under spinal anaesthesia has a severe frontal and occipital headache that is worse on standing and relieved when lying flat, with neck…
- Labour: contraindications to neuraxial block · ApplicationA woman in labour has a platelet count of 40,000 per microlitre with a prolonged prothrombin time and a request for epidural analgesia. Why is the epidural contraindica…
- Labour: umbilical cord blood gases · Multi-stepA term neonate is born flat after a prolonged deceleration. Umbilical arterial cord blood shows pH 6.95 and a base deficit of 14 mmol/L. How is this interpreted?
- Labour: intrauterine resuscitation · Multi-stepA woman receiving an oxytocin infusion has a cardiotocograph showing recurrent late decelerations with reduced variability. Which action should be taken first?
- Labour: neglected transverse lie · Multi-stepA multiparous woman at term in labour for 20 hours has a transverse lie with the back down, a prolapsed arm, the shoulder impacted in the pelvis and a tender uterus wit…
- Labour: compound presentation · ApplicationA woman at term in early labour is found to have a hand lying alongside the vertex presenting part. Labour is progressing and the fetal heart is normal. What is the usu…
- Labour: fundal pressure · ApplicationA midwife is asked to apply Kristeller manoeuvre (fundal pressure) during the second stage to hasten delivery of a slowly descending head. What is the current recommend…
- Labour: Burns-Marshall method · Multi-stepDuring a vaginal breech delivery, the trunk and arms are delivered and the baby is allowed to hang until the nape of the neck is visible under the pubic arch. The assis…
- Labour · ApplicationWhat marks the start of the second stage of labour?
- Labour · ApplicationWhat is the third stage of labour?
- Labour · ApplicationWhich feature best indicates established labour?
- Labour · ApplicationWhat is the first manoeuvre for shoulder dystocia after calling for help?
Gynaecological endocrinology51
- Gynaecological endocrinology · ApplicationAn 18-year-old has primary amenorrhoea with normal breast development and normal pubic and axillary hair. Karyotype is 46,XX and ultrasound shows absence of the uterus…
- Gynaecological endocrinology · ApplicationA phenotypic woman has primary amenorrhoea, well-developed breasts, scanty axillary and pubic hair, a blind vagina and inguinal masses. Karyotype is 46,XY with normal-t…
- Gynaecological endocrinology: PCOS · ApplicationA 24-year-old woman has 4 periods a year, acne, hirsutism and a BMI of 29. Ultrasound shows 24 follicles of 2 to 9 mm in each ovary. Under the Rotterdam criteria, how m…
- Gynaecological endocrinology: androgen insensitivity · ApplicationA phenotypic girl presents with primary amenorrhoea, well-developed breasts, scanty pubic and axillary hair, a short blind vagina and inguinal swellings. Which karyotyp…
- Gynaecological endocrinology: Kallmann syndrome · ApplicationA tall 17-year-old girl with primary amenorrhoea, absent breast development and anosmia has low FSH, low LH and low oestradiol. What is the cause?
- Gynaecological endocrinology: Asherman syndrome · ApplicationA woman develops hypomenorrhoea and secondary amenorrhoea after vigorous curettage for retained products. Her pregnancy test and hormone levels are normal. What is the…
- Gynaecological endocrinology: premature ovarian insufficiency · ApplicationA 32-year-old woman has 8 months of amenorrhoea, hot flushes and two FSH measurements of 55 IU/L a month apart. What is the diagnosis?
- Gynaecological endocrinology: hirsutism · ApplicationA woman with PCOS and distressing hirsutism does not desire pregnancy. Which combination is appropriate?
- Gynaecological endocrinology: AUB classification · ApplicationIn the FIGO PALM-COEIN classification of abnormal uterine bleeding, the letter 'O' stands for:
- Gynaecological endocrinology: heavy menstrual bleeding · ApplicationA 40-year-old woman with heavy menstrual bleeding, a normal uterus on ultrasound and who desires contraception is best treated initially with:
- Gynaecological endocrinology: adolescent bleeding · Multi-stepA 14-year-old with acute heavy bleeding, Hb 6 g/dL and unstable vital signs needs urgent treatment. After resuscitation, which treatment is appropriate to arrest the bl…
- Gynaecological endocrinology: coagulopathy · ApplicationA teenager has heavy menses since menarche, easy bruising and prolonged bleeding after dental extraction. Which is the commonest underlying bleeding disorder?
- Gynaecological endocrinology: adenomyosis · ApplicationA 42-year-old multiparous woman has progressive dysmenorrhoea, heavy menses and a uniformly enlarged, globular tender uterus. What is the most likely diagnosis and best…
- Gynaecological endocrinology: LH surge · ApplicationIn a regular 28-day cycle the luteinising hormone surge begins on day 12. When is ovulation expected?
- Gynaecological endocrinology: luteal phase length · ApplicationA woman has regular 35-day cycles. On approximately which day does she ovulate?
- Gynaecological endocrinology: McCune-Albright syndrome · ApplicationA 5-year-old girl has vaginal bleeding and breast development. She has irregular café-au-lait macules with jagged borders and a bone scan shows fibrous dysplasia. Gonad…
- Gynaecological endocrinology: congenital adrenal hyperplasia · Multi-stepA newborn with 46,XX karyotype has an enlarged clitoris and fused labioscrotal folds. On day 8 she is vomiting and dehydrated with sodium 123 mmol/L and potassium 7.1 m…
- Gynaecological endocrinology: Swyer syndrome · Multi-stepA 17-year-old with primary amenorrhoea has no breast development, normal female external genitalia, a small uterus on ultrasound, and elevated FSH and LH. Karyotype is…
- Gynaecological endocrinology: GnRH pulsatility · ApplicationWhy does continuous administration of a GnRH agonist suppress ovarian function, while pulsatile administration stimulates it?
- Gynaecological endocrinology: maturation index · ApplicationA vaginal smear is used to assess hormonal status. Which finding on the maturation index indicates a high oestrogen effect?
- Gynaecological endocrinology: acute heavy bleeding · ApplicationA haemodynamically stable 38-year-old with heavy menstrual bleeding for 10 days and normal pelvic ultrasound needs medical control of bleeding. Which oral regimen is co…
- Gynaecological endocrinology: endometrial sampling · ApplicationA 48-year-old obese woman with type 2 diabetes has had irregular heavy periods for 8 months. Transvaginal ultrasound shows a thickened endometrium without a focal lesio…
- Gynaecological endocrinology: 5-alpha reductase deficiency · Multi-stepA child raised as a girl with ambiguous genitalia at birth develops deepening of the voice, muscle mass and phallic enlargement at puberty. Karyotype is 46,XY, testoste…
- Gynaecological endocrinology: Asherman syndrome · Multi-stepA woman who had vigorous curettage after a miscarriage now has hypomenorrhoea with normal hormone levels and no withdrawal bleed after oestrogen and progestogen. What i…
- Gynaecological endocrinology: endometrial hyperplasia · Multi-stepA 42-year-old obese woman with heavy irregular bleeding has endometrial biopsy showing hyperplasia without atypia. What is the preferred treatment?
- Gynaecological endocrinology: polycystic ovary syndrome · ApplicationA 26-year-old woman with polycystic ovary syndrome has had oligomenorrhoea for eight years without treatment. Which malignancy is she at increased risk of because of ch…
- Gynaecological endocrinology: secondary amenorrhoea · Multi-stepA 22-year-old marathon runner with a BMI of 17 has had no periods for 8 months. Pregnancy test, TSH and prolactin are normal, and FSH, LH and oestradiol are low. What i…
- Gynaecological endocrinology: genital fistula · Multi-stepAfter prolonged obstructed labour, a woman has continuous leakage of urine. A tampon test with methylene blue instilled in the bladder stains the upper tampon blue. Wha…
- Gynaecological endocrinology: Turner syndrome and pregnancy · Multi-stepA 28-year-old woman with Turner syndrome (45,X) plans pregnancy using a donated oocyte. Which pre-conception evaluation is most important?
- Gynaecological endocrinology: route of oestrogen in HRT · ApplicationWhy is transdermal oestradiol associated with a lower risk of venous thromboembolism than oral oestrogen in menopausal hormone therapy?
- Gynaecological endocrinology: coelomic metaplasia · Multi-stepA 14-year-old premenarchal girl is found to have an ovarian endometrioma. Which theory best explains endometriosis in a girl who has never menstruated?
- Gynaecological endocrinology: secondary amenorrhoea work-up · ApplicationA 26-year-old has had 8 months of amenorrhoea. Pregnancy test, TSH and prolactin are normal. She does not bleed after a 10-day progestogen course, but she does bleed af…
- Gynaecological endocrinology: GnRH agonist with add-back therapy · ApplicationA woman with endometriosis is given a GnRH agonist for 6 months. Which addition limits her hot flushes and bone loss without losing the benefit on the disease?
- Gynaecological endocrinology: virilisation with raised adrenal androgen · Multi-stepA 30-year-old has rapidly progressive hirsutism and voice deepening over 5 months. Total testosterone and serum DHEAS are both markedly raised, and both ovaries look no…
- Gynaecological endocrinology: non-classic 21-hydroxylase deficiency · ApplicationA 22-year-old has hirsutism, acne and irregular cycles. Non-classic 21-hydroxylase deficiency is suspected because an early-morning follicular-phase steroid precursor i…
- Gynaecological endocrinology: hypothyroidism with hyperprolactinaemia · Multi-stepA 28-year-old has amenorrhoea, galactorrhoea, fatigue and weight gain. TSH is markedly raised with low free T4, prolactin is moderately raised, and MRI shows symmetrica…
- Gynaecological endocrinology: drug-induced hyperprolactinaemia · ApplicationA 24-year-old woman on an antipsychotic develops amenorrhoea and galactorrhoea. Pituitary MRI is normal. Which drug is most likely responsible?
- Gynaecological endocrinology: hook effect in prolactin assay · Multi-stepA woman with amenorrhoea, headache and bitemporal hemianopia has a 3 cm pituitary macroadenoma, yet serum prolactin is only mildly raised. What is the most appropriate…
- Gynaecological endocrinology: macroprolactinaemia · Multi-stepA woman with mildly raised prolactin has regular cycles, no galactorrhoea and a normal pituitary MRI. After polyethylene glycol precipitation, her measured prolactin fa…
- Gynaecological endocrinology: central precocious puberty · ApplicationA 6-year-old girl has had breast budding and a growth spurt for 6 months. Bone age is advanced, LH rises markedly after GnRH stimulation, and brain MRI is normal. What…
- Gynaecological endocrinology: metformin in PCOS · ApplicationHow does metformin help restore ovulation in an obese woman with PCOS?
- Gynaecological endocrinology: SHBG and free testosterone · ApplicationAn obese woman with PCOS has severe hirsutism although her total testosterone is only mildly raised. What best explains this?
- Gynaecological endocrinology: raloxifene · Multi-stepA 62-year-old woman has osteoporosis, a strong family history of breast cancer, no hot flushes and no previous thromboembolism. Which drug treats the bone and also lowe…
- Gynaecological endocrinology: hot flushes on tamoxifen · Multi-stepA woman taking tamoxifen after breast cancer has troublesome hot flushes and cannot use systemic oestrogen. Which antidepressant is preferred because it spares the enzy…
- Gynaecological endocrinology: preoperative fibroid shrinkage · ApplicationA woman with a 10 cm fibroid and haemoglobin of 8 g/dL is planned for myomectomy in 3 months. Which pre-treatment shrinks the fibroid and allows haemoglobin to recover?
- Gynaecological endocrinology: Y chromosome material in Turner phenotype · ApplicationA 16-year-old with Turner phenotype has primary amenorrhoea, streak gonads and a 45,X/46,XY karyotype. What is advised?
- Gynaecological endocrinology: spironolactone counselling · ApplicationA woman with PCOS is prescribed spironolactone for hirsutism. What counselling is essential?
- Gynaecological endocrinology: puberty induction in Turner syndrome · ApplicationHow is puberty induced in a 13-year-old with Turner syndrome and hypergonadotropic hypogonadism?
- Gynaecological endocrinology: screening for Cushing syndrome · ApplicationA woman with hirsutism, central obesity, purple striae, hypertension and proximal weakness needs screening for Cushing syndrome. Which test is suitable?
- Gynaecological endocrinology: autoimmune primary ovarian insufficiency · Multi-stepA 27-year-old has primary ovarian insufficiency with a normal karyotype and normal fragile X premutation testing. Which additional screening is most important?
- Gynaecological endocrinology: Herlyn-Werner-Wunderlich syndrome · Multi-stepA 13-year-old has cyclic pelvic pain, a tender paravaginal mass and regular menses from one side. Imaging shows a double uterus with an obstructed hemivagina. Which ass…
Contraception47
- Contraception · ApplicationA woman presents three days after unprotected intercourse and wants the most effective method of emergency contraception. Which should be offered?
- Contraception · ApplicationA 32-year-old woman who has migraine with visual aura wants a contraceptive. Which method should be avoided?
- Contraception: Pearl index · ApplicationThe Pearl index is defined as the number of contraceptive failures per:
- Contraception: emergency contraception · ApplicationWhich is the most effective method of emergency contraception?
- Contraception: LNG-IUS · ApplicationThe 52 mg levonorgestrel intrauterine system provides effective contraception for at least:
- Contraception: injectables · ApplicationIn the Indian national family planning programme, the injectable contraceptive 'Antara' contains:
- Contraception: centchroman · ApplicationThe non-steroidal weekly oral contraceptive 'Chhaya' (centchroman) is a:
- Contraception: permanent methods · ApplicationAfter vasectomy, couples are advised to use another method until:
- Contraception: postpartum sterilisation · ApplicationThe Pomeroy technique of tubal ligation involves:
- Contraception: implant · ApplicationA subdermal etonogestrel implant (Implanon) provides contraception for up to:
- Contraception: progestin-only pill timing · ApplicationA woman on a traditional progestogen-only pill realises she took her usual pill 5 hours late yesterday and had unprotected sex since. What is the advice?
- Contraception: missed combined pills · Multi-stepA woman on a 21-day combined pill regimen forgets two pills in the third week of a pack. What is the correct advice?
- Contraception: Actinomyces-like organisms on cervical cytology · ApplicationA woman with an intrauterine contraceptive device has a cervical smear reporting Actinomyces-like organisms. She is asymptomatic. What is the best management?
- Contraception: missing IUCD threads · ApplicationA woman with a copper IUCD inserted 2 years ago cannot feel the threads and they are not visible at the os. What is the first step?
- Contraception: WHO medical eligibility criteria · ApplicationIn the WHO medical eligibility criteria for contraceptive use, what does category 3 mean?
- Contraception: perimenopausal women · ApplicationA 52-year-old woman using a barrier method has had her last menstrual period 8 months ago. When can she stop contraception?
- Contraception: enzyme-inducing drugs · Multi-stepA 26-year-old with epilepsy on carbamazepine wants highly effective contraception. Which method is least affected by her drug?
- Contraception: postpartum combined pills · Multi-stepA woman delivered 4 weeks ago and is exclusively breastfeeding. She asks to start the combined pill. What is the advice?
- Contraception: pregnancy with IUCD in situ · Multi-stepA woman with a copper IUCD in situ has a positive pregnancy test at 7 weeks with an intrauterine sac on ultrasound. The threads are visible at the cervix. What is the b…
- Contraception: post-abortion contraception · ApplicationA woman has an uncomplicated first-trimester surgical abortion and wants long-term contraception. What is the advice regarding IUCD insertion?
- Contraception: ectopic risk with IUCD · Multi-stepA woman using a copper IUCD for 3 years has lower abdominal pain, missed period and a positive urine pregnancy test. What is the most important diagnosis to exclude fir…
- Contraception: progestogen-only bleeding · ApplicationA woman with a contraceptive implant has been troubled by irregular light bleeding for 3 months. Pregnancy is excluded and there are no contraindications to oestrogen.…
- Contraception: history of venous thromboembolism · Multi-stepA 34-year-old with a previous unprovoked deep vein thrombosis asks about contraception. Which choice is suitable?
- Contraception: antiphospholipid antibodies · Multi-stepA 28-year-old with systemic lupus erythematosus and positive antiphospholipid antibodies needs contraception. Which method should be avoided?
- Contraception: breast cancer · ApplicationA 42-year-old woman with current oestrogen receptor positive breast cancer wants contraception. Which method is suitable?
- Contraception: hypertension · Multi-stepA 38-year-old has a persistent blood pressure of 165/105 mmHg and asks for the combined pill. How is this classified under the WHO medical eligibility criteria?
- Contraception: smoking over 35 · ApplicationA 37-year-old who smokes 20 cigarettes daily requests the combined oral contraceptive pill. What is the advice?
- Contraception: emergency contraception in obesity · Multi-stepA woman with a BMI of 36 kg/m2 presents 48 hours after unprotected intercourse requesting emergency contraception. Which is the best option?
- Contraception: initiation after childbirth · ApplicationA woman who delivered 3 weeks ago, who is not breastfeeding, requests a progestogen-only implant. What is the advice?
- Contraception: breakthrough bleeding with COC · ApplicationA woman in her second month of a low-dose combined pill has light spotting in the middle of the pack but no missed pills, drug interaction or other symptoms. What is th…
- Contraception · ApplicationWhich method provides protection against many STIs?
- Contraception · ApplicationWhich long-acting reversible method is placed in the uterus?
- Contraception · ApplicationWhich method is a progestogen-containing implant?
- Contraception · ApplicationWhich method also reduces the risk of many sexually transmitted infections?
- Contraception · ApplicationWhat is the primary mechanism of a copper intrauterine device?
- Contraception · ApplicationWhat is emergency contraception intended to do?
- Contraception · ApplicationWhat is a benefit of long-acting reversible contraception?
- Contraception · ApplicationWhich method also reduces risk of many sexually transmitted infections?
- Contraception · ApplicationWhat is the main contraceptive action of a copper IUD?
- Contraception · ApplicationWhich contraceptive method also provides protection against many sexually transmitted infections?
- Contraception · ApplicationWhat is a key noncontraceptive benefit of a levonorgestrel intrauterine system?
- Contraception · ApplicationWhich method is most appropriate for emergency contraception within five days when also seeking ongoing highly effective contraception?
- Contraception · ApplicationWhich contraceptive method is contraindicated in a patient with current breast cancer?
- Contraception: combined hormonal contraception · ApplicationWhich medical history is a major contraindication to estrogen-containing combined hormonal contraception?
- Contraception: intrauterine device · ApplicationA patient with a copper intrauterine device has a positive pregnancy test and unilateral pelvic pain. What diagnosis requires urgent exclusion?
- Contraception: progestogen-only methods · ApplicationWhich patient is most likely to be offered a progestogen-only contraceptive rather than combined estrogen-progestogen contraception?
- Contraception: emergency contraception · ApplicationWhich statement about a copper intrauterine device used for emergency contraception is correct?
Complications of pregnancy45
- Complications of pregnancy: hyperemesis gravidarum · ApplicationA woman at 9 weeks has persistent vomiting, weight loss of 6 per cent, ketonuria and dehydration. Which is the appropriate first step in addition to IV fluids?
- Complications of pregnancy: hypothyroidism · ApplicationA woman on stable levothyroxine for hypothyroidism has a positive pregnancy test. What is the correct adjustment?
- Complications of pregnancy: thyroid storm · Multi-stepWhich antithyroid drug is preferred in the first trimester for Graves disease?
- Complications of pregnancy: missed abortion · ApplicationA woman at 11 weeks has a brownish discharge, regression of pregnancy symptoms and an ultrasound with a crown-rump length of 8 mm and no cardiac activity. What is the p…
- Complications of pregnancy: MTP Act · ApplicationUnder the MTP (Amendment) Act 2021, up to what gestation can a single registered medical practitioner's opinion allow termination for a woman?
- Complications of pregnancy: medical abortion · ApplicationIn India, medical termination of pregnancy with mifepristone and misoprostol is approved up to which gestation?
- Complications of pregnancy: septic abortion · ApplicationA woman presents with fever, foul-smelling discharge, uterine tenderness and shock after an unsafe abortion. Which is the best initial management?
- Complications of pregnancy: recurrent pregnancy loss · ApplicationWhat is the most common cause of sporadic first-trimester pregnancy loss?
- Complications of pregnancy: antiphospholipid syndrome · Multi-stepA woman has had three unexplained first-trimester losses and persistently positive lupus anticoagulant. Which treatment improves live birth in her next pregnancy?
- Complications of pregnancy: cervical insufficiency · ApplicationA woman has had two painless second-trimester losses at 18 and 20 weeks with a bulging membranes presentation. Which management is most appropriate in her next pregnancy?
- Complications of pregnancy: fetal growth restriction · ApplicationFetal growth restriction is best defined as an estimated fetal weight below which centile?
- Complications of pregnancy: Rh isoimmunisation · Multi-stepA woman with an Rh-negative blood group and a previous affected baby has a rising indirect Coombs titre of 1:64. What is the next step in monitoring?
- Complications of pregnancy: ovarian cyst · Multi-stepA 22-week pregnant woman has a 9 cm simple unilocular ovarian cyst found incidentally, with no symptoms and normal tumour markers. What is the best approach?
- Complications of pregnancy: trauma · Multi-stepA 32-week pregnant woman has a low-speed road traffic accident with minor abdominal bruising and is haemodynamically stable. Fetal heart is normal. What is the most app…
- Complications of pregnancy: modified WHO class IV cardiac disease · Multi-stepA 24-year-old woman with a known large atrial septal defect and Eisenmenger syndrome presents at 8 weeks of gestation. She is cyanosed with oxygen saturation of 84 perc…
- Complications of pregnancy: interpreting the 75 g OGTT · ApplicationA woman at 26 weeks undergoes a 75 g oral glucose tolerance test. Her fasting plasma glucose is 95 mg/dL, 1-hour value 170 mg/dL and 2-hour value 140 mg/dL. What is the…
- Complications of pregnancy: ectopic pregnancy · Multi-stepA haemodynamically stable woman with an unruptured tubal ectopic pregnancy is being considered for methotrexate. Which finding makes medical treatment unsuitable?
- Complications of pregnancy: oligohydramnios · ApplicationA mid-trimester scan shows no amniotic fluid, absent fetal bladder and non-visualised kidneys. What is the most important cause of death in the newborn with this condit…
- Complications of pregnancy: cardiac disease · ApplicationA woman with moderate rheumatic mitral stenosis is stable throughout pregnancy. When is she at greatest risk of pulmonary oedema?
- Complications of pregnancy: gestational trophoblastic disease · Multi-stepEight weeks after evacuation of a complete mole, a woman's hCG has plateaued over three weeks (four weekly measurements). She is not pregnant. Which diagnosis fits?
- Complications of pregnancy: cardiac disease · ApplicationA pregnant woman with mitral stenosis develops breathlessness at 28 weeks when her heart rate rises with fever. What is the mechanism of her deterioration?
- Complications of pregnancy: indication for classical caesarean · ApplicationIn which situation is a classical (vertical upper segment) uterine incision most appropriate?
- Complications of pregnancy: mitral stenosis after delivery · Multi-stepA woman with severe mitral stenosis delivers vaginally under epidural analgesia. Two hours later she becomes breathless with bilateral crepitations. Which mechanism bes…
- Complications of pregnancy: Jarisch-Herxheimer reaction · ApplicationA woman at 28 weeks with early syphilis receives benzathine penicillin. Within hours she has fever, uterine contractions and reduced fetal movements. What explains thes…
- Complications of pregnancy: indomethacin as tocolytic · ApplicationA drug used for short-term tocolysis before 32 weeks can cause oligohydramnios and premature constriction of the fetal ductus arteriosus. Which is it?
- Complications of pregnancy: twin anaemia-polycythaemia sequence · Multi-stepIn monochorionic twins at 28 weeks, amniotic fluid volumes are similar, but the middle cerebral artery peak velocity is raised in one twin and low in the other. At birt…
- Complications of pregnancy: locked twins · Multi-stepIn a twin labour the first twin presents by the breech and the second twin by the vertex. After the trunk of the first twin is delivered, the aftercoming head will not…
- Complications of pregnancy: interstitial ectopic pregnancy · Multi-stepA woman at 10 weeks of amenorrhoea collapses with haemoperitoneum. Which ectopic site best explains rupture this late and with torrential bleeding?
- Complications of pregnancy: Spiegelberg criteria · Multi-stepAt laparotomy a ruptured gestational sac is found within the ovary. The tube on that side is intact, the sac is in the position of the ovary, it is attached to the uter…
- Complications of pregnancy: hook effect in molar pregnancy · Multi-stepA woman at 14 weeks has vaginal bleeding with grape-like vesicles, and a uterus larger than dates. A urine pregnancy test is negative, but serum hCG is above 1,000,000…
- Complications of pregnancy: thyrotoxicosis in molar pregnancy · ApplicationA woman with a complete hydatidiform mole has tachycardia, tremor and a suppressed TSH. What is the mechanism?
- Complications of pregnancy: posterior colpotomy · Multi-stepA woman with pelvic inflammatory disease has fever despite intravenous antibiotics, and a tender fluctuant mass bulges into the posterior fornix. How is this pelvic abs…
- Complications of pregnancy: PUPPP · ApplicationA primigravida at 35 weeks has intense itching with erythematous urticarial papules that began within her abdominal striae and spare the periumbilical skin. There are n…
- Complications of pregnancy: pyelonephritis in pregnancy · ApplicationA woman at 24 weeks has a temperature of 39 degrees C, right flank pain, vomiting and tenderness at the costovertebral angle. Urine microscopy shows many pus cells and…
- Complications of pregnancy: immune thrombocytopenia · ApplicationA woman at 14 weeks, known since adolescence to have an isolated low platelet count of about 60,000 per microlitre, has no bleeding and a normal blood pressure. Her per…
- Complications of pregnancy: gastroschisis · ApplicationAn anomaly scan at 20 weeks shows loops of bowel floating freely in the amniotic fluid, arising from a small defect to the right of a normally inserted umbilical cord.…
- Complications of pregnancy: omphalocele · Multi-stepA fetus at 18 weeks has a midline anterior abdominal wall defect with liver and bowel herniating into a membrane-covered sac to which the umbilical cord is attached. Wh…
- Complications of pregnancy: velamentous cord insertion · ApplicationOn inspection of a delivered placenta, the umbilical vessels separate from each other at the edge and run through the fetal membranes for some distance, unprotected by…
- Complications of pregnancy: Kell alloimmunisation · Multi-stepA woman with anti-Kell antibodies has a fetus with severe anaemia and hydrops, although her antibody titre is only modest and the amniotic fluid bilirubin level is low.…
- Complications of pregnancy: contraindication to tocolysis · ApplicationA woman at 30 weeks with threatened preterm labour is being considered for tocolysis to allow antenatal corticosteroids to act. In which situation should tocolysis be a…
- Complications of pregnancy: misoprostol embryopathy · ApplicationA woman used misoprostol at 6 weeks in an unsuccessful attempt to end her pregnancy. The child is born with facial nerve paralysis, an expressionless face, inability to…
- Complications of pregnancy: neonatal hypoglycaemia in diabetic mothers · ApplicationA baby of a mother with poorly controlled diabetes is jittery with a blood glucose of 25 mg/dL one hour after birth. Which mechanism explains the hypoglycaemia?
- Complications of pregnancy: theca lutein cysts in mole · ApplicationAfter suction evacuation of a complete hydatidiform mole, a 24-year-old woman is found to have bilateral enlarged multilocular ovarian cysts of about 8 cm. She is haemo…
- Complications of pregnancy: Marfan syndrome and pregnancy · Multi-stepA tall woman with arachnodactyly and ectopia lentis is found to have an aortic root of 4.8 cm on echocardiography. She wishes to conceive. What is the most appropriate…
- Complications of pregnancy: chlamydia in pregnancy · ApplicationA woman at 20 weeks has a positive nucleic acid test for Chlamydia trachomatis from an endocervical swab. Which drug is preferred for treatment?
Gynecology42
- Gynecology: PID · ApplicationPelvic pain, fever, cervical-motion tenderness suggest what?
- Gynecology: torsion · ApplicationSudden unilateral pelvic pain with vomiting and adnexal mass suggests what?
- Gynecology: adenomyosis · ApplicationHeavy painful periods with diffusely enlarged tender uterus suggest what?
- Gynecology: prolapse · ApplicationPosterior vaginal wall prolapse involving rectum is called what?
- Gynecology · ApplicationWhat is dysmenorrhea?
- Gynecology · ApplicationA patient reports menstrual periods that are abnormally heavy and interfere with daily activities. Which term best describes this complaint?
- Gynecology · ApplicationPainful intercourse with cyclic pelvic pain suggests what?
- Gynecology · ApplicationHeavy bleeding and bulky irregular uterus suggest what?
- Gynecology · ApplicationFever and adnexal tenderness with discharge suggest what?
- Gynecology · ApplicationWhat can cause secondary amenorrhea?
- Gynecology · ApplicationWhat symptom commonly suggests endometriosis?
- Gynecology · ApplicationWhat is the most common benign uterine tumor?
- Gynecology · ApplicationWhat is a common presentation of uterine fibroids?
- Gynecology · ApplicationWhat symptom often occurs with polycystic ovary syndrome?
- Gynecology · ApplicationA patient has recurrent cramping pelvic pain that occurs with menstrual bleeding; which term describes this symptom?
- Gynecology · ApplicationA nonpregnant adult has no menstrual bleeding for six consecutive months; which term best describes this presentation?
- Gynecology · ApplicationWhat symptom can be caused by pelvic organ prolapse?
- Gynecology · ApplicationWhat symptom is common in adenomyosis?
- Gynecology · ApplicationWhat is a common symptom of ovarian torsion?
- Gynecology · ApplicationWhat is a major risk associated with prolonged unopposed estrogen exposure?
- Gynecology · ApplicationWhat is a key concern with postmenopausal bleeding?
- Gynecology · ApplicationWhat syndrome combines irregular ovulation, hyperandrogenism, and polycystic ovaries?
- Gynecology · ApplicationWhat procedure removes the uterine lining to investigate persistent abnormal bleeding?
- Gynecology: pelvic inflammatory disease · ApplicationA sexually active patient has pelvic pain, fever, mucopurulent cervical discharge, and cervical motion tenderness. What is the most likely diagnosis?
- Gynecology: ovarian torsion · Multi-stepA patient has sudden unilateral lower-abdominal pain with vomiting and an adnexal mass. Doppler flow is present in the ovary. What is the correct interpretation?
- Gynecology: endometriosis · ApplicationA patient has progressive dysmenorrhea, deep dyspareunia, and cyclical pelvic pain, with infertility. Which diagnosis is most likely?
- Gynecology: polycystic ovary syndrome · ApplicationA patient has irregular menses, clinical hyperandrogenism, and polycystic ovarian morphology after other causes are excluded. Which diagnosis fits best?
- Gynecology: abnormal uterine bleeding · ApplicationA 54-year-old has postmenopausal bleeding. Which investigation is essential to exclude endometrial malignancy?
- Gynecology: cervical cancer screening · ApplicationWhat is the main purpose of cervical screening programs?
- Gynecology: adenomyosis · ApplicationA patient has heavy painful periods, a diffusely enlarged tender boggy uterus, and no discrete fibroid mass. What diagnosis is most likely?
- Gynecology: leiomyoma · ApplicationA patient has heavy menstrual bleeding, pressure symptoms, and an irregularly enlarged firm uterus. What is the most likely diagnosis?
- Gynecology: ovarian malignancy · ApplicationA postmenopausal patient has an adnexal mass with ascites, early satiety, and unintentional weight loss. What is the primary concern?
- Gynecology: stress urinary incontinence · ApplicationA patient leaks urine when coughing, laughing, and exercising, without urgency or dysuria. What type of incontinence is most likely?
- Gynecology: prolapse · ApplicationA multiparous patient reports a vaginal bulge and urinary pressure; examination shows the anterior vaginal wall descending. What is the likely prolapse type?
- Gynecology: menopause · ApplicationWhich symptom is most characteristic of the menopausal transition due to fluctuating ovarian hormone production?
- Gynecology: primary amenorrhea · ApplicationA 16-year-old has normal breast development, absent uterus on imaging, and a short blind-ending vagina. What diagnosis is most likely?
- Gynecology: complete androgen insensitivity · ApplicationA phenotypic female has primary amenorrhea, normal breast development, scant pubic hair, absent uterus, and an inguinal gonad. What diagnosis is likely?
- Gynecology: premature ovarian insufficiency · ApplicationA 34-year-old has amenorrhea, hot flushes, elevated FSH on repeated testing, and low estradiol. What diagnosis is most likely?
- Gynecology: dysmenorrhea · ApplicationA patient has progressive secondary dysmenorrhea, deep dyspareunia, and a fixed retroverted uterus with uterosacral nodularity. What diagnosis is most likely?
- Gynecology: pelvic organ prolapse · ApplicationA patient with posterior vaginal-wall bulge must press on the vagina to complete defecation. Which prolapse is most likely?
- Gynecology: ovarian torsion · Multi-stepA patient with known ovarian cyst has sudden unilateral pelvic pain, vomiting, and adnexal tenderness. What is the correct management priority?
- Gynecology: PID complications · ApplicationWhich long-term complication is increased after recurrent pelvic inflammatory disease?
Infertility36
- Infertility · ApplicationA couple has been trying to conceive for 18 months. The woman has regular cycles. What is the first investigation to arrange for the male partner?
- Infertility · ApplicationWhen is hysterosalpingography best performed in an infertility work-up?
- Infertility · Multi-stepA 29-year-old woman develops secondary amenorrhoea after vigorous curettage for retained products. She has normal FSH and no withdrawal bleed after oestrogen followed b…
- Infertility: tubal assessment · ApplicationWhich investigation is the gold standard for assessing tubal patency and pelvic pathology?
- Infertility: male hypogonadism · ApplicationA tall man with small firm testes, gynaecomastia and azoospermia has high FSH and LH and low testosterone. What is the karyotype?
- Infertility: ovulation induction · ApplicationWhich drug is currently considered first-line for ovulation induction in women with PCOS?
- Infertility: OHSS · ApplicationA woman 5 days after hCG trigger for IVF has abdominal distension, ascites, haemoconcentration and oliguria. What is the diagnosis?
- Infertility: assisted reproduction · ApplicationA woman with bilateral hydrosalpinges and normal semen analysis is best managed by:
- Infertility: ICSI · ApplicationIntracytoplasmic sperm injection is mainly indicated for:
- Infertility: ovarian reserve · ApplicationWhich test best reflects ovarian reserve and is independent of the day of the menstrual cycle?
- Infertility: uterine septum · ApplicationA woman with recurrent second-trimester losses has a septate uterus on 3D ultrasound. What is the treatment?
- Infertility: genital tuberculosis · ApplicationIn a woman with infertility, HSG showing beaded tubes, a rigid tube and intrauterine adhesions suggests:
- Infertility: basal body temperature · ApplicationA woman records her basal body temperature daily on waking. What pattern indicates that ovulation has occurred?
- Infertility: WHO semen reference limits · ApplicationAccording to the WHO 2021 (sixth edition) lower reference limits for semen analysis, which set of values is correct?
- Infertility: retrograde ejaculation · ApplicationA 35-year-old diabetic man has a very low semen volume with azoospermia on semen analysis and reports a dry orgasm. What test confirms the cause?
- Infertility: intrauterine insemination requirements · ApplicationWhich condition must be met before offering intrauterine insemination to a couple?
- Infertility: preimplantation genetic testing · ApplicationA couple who are both carriers of beta-thalassaemia wish to conceive by IVF and avoid an affected child without a later termination. Which technique is suitable?
- Infertility: luteal phase support · ApplicationWhy is luteal phase support with progesterone routinely given after oocyte retrieval in IVF cycles?
- Infertility: poor ovarian response · Multi-stepWhich patient meets the Bologna criteria for poor ovarian responders?
- Infertility: unexplained infertility · Multi-stepA 31-year-old couple has had 2 years of infertility with normal semen, patent tubes on HSG, and confirmed ovulation. What is the usual stepwise treatment?
- Infertility: congenital absence of vas deferens · Multi-stepA 30-year-old man with chronic sinopulmonary infections has azoospermia, low semen volume with low pH and low fructose. His testes are of normal size and the vasa are n…
- Infertility: blastocyst transfer · ApplicationIn an IVF cycle, which description of a blastocyst-stage embryo transfer is correct?
- Infertility: saline infusion sonography · ApplicationA woman with infertility and heavy bleeding has a thickened endometrium on routine ultrasound. Which test best distinguishes endometrial polyps and submucous fibroids?
- Infertility: elective single embryo transfer · ApplicationWhat is the main advantage of elective single embryo transfer in a young woman with good-quality embryos?
- Infertility: minimal endometriosis · Multi-stepA 30-year-old with 2 years of unexplained infertility has stage I peritoneal endometriosis seen at diagnostic laparoscopy. Which statement is correct about management t…
- Infertility: gonadotropin stimulation monitoring · ApplicationA woman on gonadotropin ovulation induction for anovulatory infertility is found on ultrasound to have five follicles over 16 mm. What is the most appropriate step?
- Infertility: hypogonadotropic amenorrhoea · Multi-stepA marathon runner has amenorrhoea with low FSH, low LH, low oestradiol and a normal prolactin and TSH. She wishes to conceive. Which treatment will induce ovulation?
- Infertility: vaginismus · ApplicationA newly married 24-year-old woman cannot permit vaginal penetration because of involuntary spasm of the pelvic muscles and fear of pain. Pelvic anatomy is normal. What…
- Infertility · ApplicationWhat confirms ovulation most directly in a cycle?
- Infertility · ApplicationWhich condition commonly causes anovulation?
- Infertility · ApplicationFailure to conceive after regular unprotected intercourse warrants evaluation of whom?
- Infertility · ApplicationWhat initial male-factor investigation is commonly included in infertility assessment?
- Infertility · ApplicationWhich investigation can assess tubal patency in infertility workup?
- Infertility · ApplicationWho should be evaluated in an infertility assessment?
- Infertility · ApplicationWhich test is commonly used to assess tubal patency during infertility work-up?
- Infertility: semen analysis · ApplicationIn an infertility evaluation, why should an abnormal semen analysis generally be repeated before drawing conclusions?
Postpartum haemorrhage and emergencies31
- Postpartum haemorrhage and emergencies: uterine inversion · Multi-stepAfter delivery of the placenta with traction, a woman has profound shock with only modest bleeding and a smooth mass at the introitus with no fundus palpable abdominall…
- Postpartum haemorrhage and emergencies: Sheehan syndrome · Multi-stepA woman who had a severe postpartum haemorrhage two years ago has failure of lactation, amenorrhoea and fatigue. Which hormone replacement must be started before thyrox…
- Postpartum haemorrhage and emergencies: PPH drug choice · Multi-stepA woman with severe pre-eclampsia has atonic PPH not responding to oxytocin. Which second-line uterotonic is contraindicated?
- Postpartum haemorrhage and emergencies: septic abortion · ApplicationAfter an unsafe abortion a woman has fever, jaundice, haemoglobinuria and acute renal failure. Which organism is classically responsible?
- Postpartum haemorrhage and emergencies: postpartum psychosis · ApplicationOn day 8 after delivery, a woman with no earlier psychiatric illness becomes insomniac and agitated, says the baby has been replaced by an impostor and hears voices tel…
- Postpartum haemorrhage and emergencies: radioactive iodine and lactation · ApplicationA breastfeeding mother with thyroid cancer needs radioactive iodine therapy. What is the correct advice?
- Postpartum haemorrhage and emergencies: controlled cord traction · ApplicationA midwife has given oxytocin 10 IU intramuscularly within a minute of birth as part of active management of the third stage. Which condition must be met before she appl…
- Postpartum haemorrhage and emergencies: oxytocin bolus effect · ApplicationAt caesarean section the anaesthetist pushes 10 IU of oxytocin as a rapid intravenous bolus. Which haemodynamic effect is most likely?
- Postpartum haemorrhage and emergencies: ergometrine and trapped placenta · ApplicationMethylergometrine is mistakenly given intravenously at delivery of the anterior shoulder, before the placenta has come out. Which complication is most likely?
- Postpartum haemorrhage and emergencies: misoprostol shivering and pyrexia · ApplicationSublingual misoprostol 800 mcg is given for atonic postpartum haemorrhage. Within an hour she has marked shivering and a temperature of 39 degrees C. The uterus is firm…
- Postpartum haemorrhage and emergencies: carboprost adverse effects · ApplicationWhich group of adverse effects is typical of carboprost given for atonic postpartum haemorrhage?
- Postpartum haemorrhage and emergencies: atony after prolonged oxytocin · Multi-stepAfter 14 hours of oxytocin augmentation, a woman delivers vaginally and then has a soft, boggy uterus that responds poorly to a further oxytocin infusion. Which explana…
- Postpartum haemorrhage and emergencies: bleeding with a firm uterus · ApplicationFifteen minutes after a forceps delivery, a woman has continuous bright red bleeding. The fundus is firm and well contracted, and the placenta and membranes are complet…
- Postpartum haemorrhage and emergencies: cervical tear repair · ApplicationA 3 cm bleeding laceration is found at the 3 o'clock position of the cervix after delivery. How should it be repaired?
- Postpartum haemorrhage and emergencies: vulval haematoma · Multi-stepTwo hours after a vacuum delivery, a woman has severe perineal pain, cannot pass urine, and has a tense, bluish swelling of the left labium that is enlarging. Pulse is…
- Postpartum haemorrhage and emergencies: choriocarcinoma after term delivery · Multi-stepSix weeks after a normal term delivery, a woman has irregular heavy bleeding. The uterus is bulky and soft, and chest X-ray shows multiple round opacities. Curettage ti…
- Postpartum haemorrhage and emergencies: planned surgery for placenta accreta · Multi-stepAntenatal MRI in a woman with a previous caesarean section and an anterior placenta praevia shows deep myometrial invasion. Which plan is best?
- Postpartum haemorrhage and emergencies: placenta percreta and bladder · Multi-stepA woman with a previous caesarean section and placenta praevia at 33 weeks develops painless gross haematuria. Urine culture is sterile. What is the most likely cause?
- Postpartum haemorrhage and emergencies: uterine relaxant in inversion · ApplicationIn acute puerperal uterine inversion, replacement under anaesthesia fails because the cervical ring has tightened around the fundus. Which drug is useful before the nex…
- Postpartum haemorrhage and emergencies: surgery for chronic inversion · ApplicationWhich operation corrects chronic uterine inversion by an abdominal approach, dividing the posterior part of the constriction ring?
- Postpartum haemorrhage and emergencies: hydrostatic replacement of inversion · ApplicationWhat is the principle of O'Sullivan's hydrostatic method for acute uterine inversion?
- Postpartum haemorrhage and emergencies: pathogenesis of amniotic fluid embolism · ApplicationWhich statement reflects the current understanding of amniotic fluid embolism?
- Postpartum haemorrhage and emergencies: antibiotics for postpartum endometritis · ApplicationOn day 3 after a caesarean following prolonged labour, a woman has temperature 39 degrees C, uterine tenderness and foul lochia. Which regimen is standard first-line?
- Postpartum haemorrhage and emergencies: replacement order in Sheehan syndrome · ApplicationA woman with Sheehan syndrome has low cortisol and low free T4. In what order should replacement begin?
- Postpartum haemorrhage and emergencies: management of breast abscess · ApplicationThree weeks after delivery, a woman has fever and a tender fluctuant breast lump despite five days of antibiotics for mastitis. Ultrasound shows a 4 cm collection. What…
- Postpartum haemorrhage and emergencies: missing cotyledon · ApplicationAfter delivery of the placenta, a cotyledon is found missing and the uterus is soft with ongoing bleeding. What is the next step?
- Postpartum haemorrhage and emergencies: uterine artery embolisation · Multi-stepA haemodynamically stable woman continues to bleed after vaginal delivery despite uterotonics, and has lost 1500 mL. An interventional radiology service is available. W…
- Postpartum haemorrhage and emergencies: delayed hypotension in obstetric haemorrhage · ApplicationA woman with postpartum haemorrhage of 1500 mL has a pulse of 120 per minute but a blood pressure of 110/70 mmHg. Why is the blood pressure still preserved?
- Postpartum haemorrhage and emergencies: nitroglycerin in retained placenta · Multi-stepThirty minutes after delivery the placenta is retained, with no active bleeding, and a constriction ring is felt at the cervix. Before manual removal in theatre, which…
- Postpartum haemorrhage and emergencies: external aortic compression · ApplicationWhile theatre is being prepared for atonic postpartum haemorrhage with shock, which temporising manoeuvre can reduce pelvic blood flow?
- Postpartum haemorrhage and emergencies: anticoagulant in lactation · ApplicationA breastfeeding woman who developed a deep vein thrombosis after delivery needs long-term oral anticoagulation. Which drug is acceptable?
Benign gynaecology30
- Benign gynaecology: fibroid degeneration · ApplicationA woman at 16 weeks has fever, severe localised abdominal pain over a known fibroid and mild leucocytosis. What is the likely diagnosis and management?
- Benign gynaecology: fibroid treatment · ApplicationA 30-year-old nulliparous woman with a 6 cm intramural fibroid and infertility wishes to preserve fertility. Which is the surgical treatment of choice?
- Benign gynaecology: pelvic organ prolapse · ApplicationWhich ligaments are the main support of the uterus against descent?
- Benign gynaecology: prolapse surgery · Multi-stepA 35-year-old woman with second-degree uterine prolapse wants to preserve her uterus. A procedure with cervical amputation and shortening of cardinal ligaments is called:
- Benign gynaecology: urinary incontinence · ApplicationA woman leaks urine on coughing and sneezing, with a negative urgency history. What is the surgical treatment of choice if conservative management fails?
- Benign gynaecology: vesicovaginal fistula · ApplicationContinuous leakage of urine per vagina after prolonged obstructed labour is most likely due to:
- Benign gynaecology: Mullerian anomalies · Multi-stepA woman with a unicornuate uterus and a non-communicating rudimentary horn is at risk of which complication?
- Benign gynaecology: cervical cytology · ApplicationA Pap smear reports ASC-US. What is the recommended next step in a woman aged 30 or more?
- Benign gynaecology: Gartner duct cyst · Multi-stepA cyst in the anterolateral wall of the vagina is most likely derived from which embryological remnant?
- Benign gynaecology: urethral caruncle · ApplicationA 65-year-old postmenopausal woman has spotting on wiping and dysuria. Examination shows a small, red, friable, tender polypoid swelling at the posterior lip of the ure…
- Benign gynaecology: functional ovarian cysts · ApplicationA 22-year-old has a 4 cm simple unilocular thin-walled ovarian cyst with no flow found incidentally. She is asymptomatic. What is the best advice?
- Benign gynaecology: haematometra · ApplicationA 55-year-old postmenopausal woman who received pelvic radiotherapy years ago has lower abdominal pain, and examination shows a firm, tender, enlarged uterus. Ultrasoun…
- Benign gynaecology: pelvic congestion syndrome · ApplicationA parous woman aged 35 has a chronic dull pelvic ache that worsens by evening, after standing and at the end of menstruation, with dyspareunia. Imaging shows dilated to…
- Benign gynaecology: ureteric injury at hysterectomy · Multi-stepOn day 4 after a total abdominal hysterectomy for fibroids, a woman has flank pain, low-grade fever and a clear watery vaginal discharge. The fluid creatinine is much h…
- Benign gynaecology: subtotal hysterectomy · ApplicationA woman undergoes a supracervical (subtotal) hysterectomy for benign disease. Which statement is correct regarding follow-up?
- Benign gynaecology: cervical polyp · ApplicationA 40-year-old has intermenstrual and postcoital spotting. Speculum examination shows a smooth red 1 cm pedunculated growth protruding through the external os. What is t…
- Benign gynaecology: prepubertal vaginal bleeding · ApplicationA 5-year-old girl has persistent blood-stained foul-smelling vaginal discharge without a history of trauma. What is the commonest cause and best next step?
- Benign gynaecology: transverse vaginal septum · ApplicationA 15-year-old with primary amenorrhoea has cyclical lower abdominal pain. Examination shows normal vulva and hymen with no bulge on straining and the vagina ends blindl…
- Benign gynaecology: vulvodynia · ApplicationA 28-year-old has burning pain at the vaginal entrance on intercourse and tampon insertion. Touching the vestibule with a cotton swab reproduces the pain, and the vulva…
- Benign gynaecology: assessment of stress incontinence · ApplicationA multiparous woman reports leakage of urine on coughing. Which bedside test assesses urethral hypermobility?
- Benign gynaecology: overactive bladder therapy · ApplicationA 60-year-old woman with overactive bladder and well-controlled hypertension and dry mouth on oxybutynin needs an alternative. Which drug acts by relaxing the detrusor…
- Benign gynaecology: colporrhaphy · ApplicationWhich operation is the standard repair for a symptomatic cystocele with a central defect in the anterior vaginal wall?
- Benign gynaecology: ring pessary complication · Multi-stepA 78-year-old woman using a ring pessary for stage III prolapse for 2 years presents with blood-stained foul vaginal discharge. Speculum examination shows an ulcer on t…
- Benign gynaecology: hysteroscopy distension medium · Multi-stepDuring hysteroscopic resection of a submucous fibroid using 1.5 percent glycine as the distension medium, the patient develops confusion, nausea and seizure. Serum sodi…
- Benign gynaecology: gas embolism at laparoscopy · Multi-stepDuring laparoscopy with carbon dioxide insufflation, the anaesthetist reports a sudden fall in end-tidal CO2, hypotension and a mill-wheel murmur. What is the immediate…
- Benign gynaecology: McCall culdoplasty · ApplicationDuring vaginal hysterectomy for uterovaginal prolapse, the surgeon approximates the uterosacral ligaments across the midline and closes the peritoneum high up. What is…
- Benign gynaecology: vault granulation tissue · ApplicationSix weeks after hysterectomy, a woman has persistent blood-stained vaginal discharge. Examination shows red, friable granulation tissue at the vaginal vault. What is th…
- Benign gynaecology: uterine perforation at suction evacuation · Multi-stepDuring suction evacuation for an incomplete abortion, the suction catheter passes without resistance, and omentum is seen at the cervical os. The patient is stable. Wha…
- Benign gynaecology: route of hysterectomy · ApplicationA 50-year-old woman needs hysterectomy for a 10-week-size fibroid uterus, with no prolapse or previous pelvic surgery. Which approach is generally preferred when feasib…
- Benign gynaecology · ApplicationWhich feature is typical of uterine fibroids?
Labour and delivery25
- Labour and delivery: episiotomy · ApplicationWhich statement correctly compares median and mediolateral episiotomy?
- Labour and delivery: malposition · ApplicationA nulliparous woman in labour has severe backache, early urge to push and slow descent. The abdomen is flat in the lower half and the fetal heart is heard in the flank.…
- Labour and delivery: Montevideo units · ApplicationMontevideo units are used to measure uterine activity in labour. How are they calculated, and what total is generally considered adequate?
- Labour and delivery: Bracht manoeuvre · ApplicationDuring an assisted breech delivery, after the umbilicus is born, the obstetrician grasps the trunk with thumbs along the fetal back and fingers around the thighs, and s…
- Labour and delivery: ventouse cup placement · ApplicationWhen applying a vacuum cup, its centre should lie over the flexion (pivot) point. Where is this located?
- Labour and delivery: outlet forceps · Multi-stepIn the standard classification of forceps delivery, which description corresponds to outlet forceps?
- Labour and delivery: amnioinfusion · Multi-stepA woman in labour with oligohydramnios develops repetitive variable decelerations with normal baseline rate and variability. Which intervention may relieve cord compres…
- Labour and delivery: baseline variability · ApplicationA cardiotocograph shows a baseline of 140 bpm with an amplitude of oscillation of 12 bpm. How is the variability classified (NICHD)?
- Labour and delivery: incoordinate uterine action · ApplicationA primigravida at term in early labour has severe continuous pain with irregular contractions and a raised resting uterine tone. The cervix has stayed 2 cm dilated over…
- Labour and delivery: myometrial gap junctions · ApplicationNear term, uterine contractions become strong and coordinated. Which myometrial change mainly allows contractions to spread synchronously across the uterus?
- Labour and delivery: placental CRH · ApplicationIn late pregnancy, a placental peptide rises exponentially in maternal blood and is implicated in the timing of labour by stimulating fetal adrenal DHEA sulphate output…
- Labour and delivery: pain pathways in the first stage · ApplicationA woman in the first stage of labour requests epidural analgesia. The pain from uterine contractions and cervical dilatation travels via visceral afferents to which spi…
- Labour and delivery: triple descending gradient · ApplicationDuring normal labour the contraction starts near a cornual pacemaker and spreads downwards, with the strongest and longest contraction in the fundus. Which term describ…
- Labour and delivery: cervical effacement in primigravida · ApplicationWhich statement describes the usual pattern of cervical changes in the first stage of labour in a primigravida compared with a multigravida?
- Labour and delivery: anthropoid pelvis · ApplicationOn clinical pelvimetry, a woman's pelvic inlet is oval, with the anteroposterior diameter greater than the transverse diameter, and the sacrum is long. Which pelvic typ…
- Labour and delivery: deep transverse arrest · Multi-stepA nulliparous woman has been pushing for 2 hours. The head is at station 0 to +1 with the sagittal suture in the transverse diameter, no rotation despite adequate contr…
- Labour and delivery: secondary arrest in active phase · Multi-stepA primigravida at term has been in labour for 14 hours. The cervix has remained at 6 cm for 5 hours despite adequate contractions on an oxytocin infusion. The head is h…
- Labour and delivery: Matthews Duncan placenta · ApplicationDuring the third stage, the placenta is expelled with its rough maternal surface presenting first, and the membranes trail behind. Which mechanism of placental separati…
- Labour and delivery: Kustner sign · ApplicationIn the third stage, the attendant presses with the hand above the symphysis pubis and notices that the umbilical cord at the vulva is drawn back into the vagina. How sh…
- Labour and delivery: oxytocin bolus hazard · ApplicationA midwife gives 10 units of oxytocin as a rapid intravenous bolus after delivery. Which adverse effect is most likely?
- Labour and delivery: Zavanelli manoeuvre · ApplicationIn severe shoulder dystocia, McRoberts position, suprapubic pressure, delivery of the posterior arm and rotational manoeuvres have all failed. Which last-resort procedu…
- Labour and delivery: pethidine and the newborn · ApplicationA woman received 100 mg of intramuscular pethidine 90 minutes before delivery. The newborn has a normal heart rate but is limp with poor respiratory effort. Which effec…
- Labour and delivery: clavicle fracture · ApplicationAfter a delivery complicated by shoulder dystocia, a newborn does not move the right arm well, cries on handling the shoulder, and has a palpable crepitus over the righ…
- Labour and delivery: Klumpke palsy · ApplicationA newborn delivered after a difficult breech extraction with traction has a claw hand, weak wrist and finger flexion, and ipsilateral Horner syndrome. Which injury is t…
- Labour and delivery: neonatal facial nerve palsy · ApplicationA newborn delivered with forceps shows asymmetry on crying: the mouth draws towards the left, the right eye does not close fully and the right forehead cannot be wrinkl…
Early pregnancy24
- Early pregnancy: ectopic pregnancy · Multi-stepA haemodynamically stable woman at 6 weeks has a 2.5 cm unruptured tubal ectopic pregnancy without fetal cardiac activity. Her serum beta-hCG is 2,500 IU/L. She is reli…
- Early pregnancy: methotrexate in ectopic pregnancy · ApplicationWhich woman with a tubal ectopic pregnancy is the best candidate for single-dose methotrexate?
- Early pregnancy: ruptured ectopic · ApplicationA woman at 7 weeks of amenorrhoea has severe lower abdominal pain, BP 80/50 mm Hg, pulse 130/min and a positive urine pregnancy test. FAST shows free fluid in Morison's…
- Early pregnancy: ultrasound and hCG · Multi-stepA woman with 6 weeks of amenorrhoea and serum hCG of 3000 mIU/mL has an empty uterus on transvaginal scan and a complex adnexal mass. What is the most likely diagnosis?
- Early pregnancy: Arias-Stella reaction · Multi-stepEndometrial curettage in a woman with suspected ectopic pregnancy shows atypical hypersecretory glands with enlarged hyperchromatic nuclei but no villi. What is this fi…
- Early pregnancy: heterotopic pregnancy · Multi-stepA 29-year-old at 7 weeks after embryo transfer for IVF (two embryos) has lower abdominal pain. Ultrasound shows a live intrauterine gestation and a complex right adnexa…
- Early pregnancy: caesarean scar pregnancy · Multi-stepA woman with two previous caesarean sections has 7 weeks of amenorrhoea and light bleeding. Transvaginal scan shows an empty uterine cavity and cervical canal with a ge…
- Early pregnancy: cervical pregnancy · ApplicationA woman at 8 weeks has painless vaginal bleeding. On examination the cervix is ballooned and barrel-shaped, with the external os partly open and the uterine fundus smal…
- Early pregnancy: anembryonic pregnancy · ApplicationA woman with 8 weeks of amenorrhoea has a transvaginal scan showing an empty gestational sac with a mean sac diameter of 26 mm and no yolk sac or embryo. What is the di…
- Early pregnancy: surgical evacuation method · ApplicationA 24-year-old with a confirmed missed miscarriage at 9 weeks who is haemodynamically stable chooses surgical management. Which method is generally preferred in the firs…
- Early pregnancy: pregnancy of unknown location · Multi-stepA woman with a positive urine test and mild abdominal pain has a serum hCG of 900 IU/L. Transvaginal ultrasound shows no intrauterine or adnexal pregnancy, and she is s…
- Early pregnancy: tubal surgery · Multi-stepA 28-year-old with an unruptured left ampullary ectopic is haemodynamically stable. Her right tube is blocked from previous pelvic infection, and she wishes future fert…
- Early pregnancy · ApplicationWhat is a key symptom of ruptured ectopic pregnancy?
- Early pregnancy · ApplicationWhat confirms an intrauterine pregnancy location?
- Early pregnancy · ApplicationWhat symptom in early pregnancy requires assessment for ectopic pregnancy?
- Early pregnancy · ApplicationWhat test confirms pregnancy by detecting a hormone?
- Early pregnancy · ApplicationWhich combination should raise concern for ectopic pregnancy?
- Early pregnancy · ApplicationWhat ultrasound finding confirms an intrauterine pregnancy?
- Early pregnancy · ApplicationWhich symptom combination raises concern for ectopic pregnancy?
- Early pregnancy · ApplicationWhat ultrasound finding confirms an intrauterine pregnancy?
- Early pregnancy: ectopic pregnancy · Multi-stepA patient at 7 weeks' gestation has unilateral pelvic pain, vaginal bleeding, shoulder-tip pain, hypotension, and free intraperitoneal fluid on ultrasound. What is the…
- Early pregnancy: miscarriage · ApplicationA patient at 9 weeks has vaginal bleeding and cramping. Ultrasound shows an intrauterine gestational sac with an embryo but no cardiac activity, meeting accepted nonvia…
- Early pregnancy: hyperemesis gravidarum · ApplicationA patient at 10 weeks has persistent vomiting, weight loss, ketonuria, and dehydration. What diagnosis is most likely?
- Early pregnancy: molar pregnancy · ApplicationA patient has vaginal bleeding, uterus larger than dates, markedly elevated hCG, severe nausea, and ultrasound showing diffuse echogenic intrauterine material without a…
Normal pregnancy and antenatal care22
- Normal pregnancy and antenatal care: anaemia · Multi-stepA woman at 20 weeks has haemoglobin 9.5 g/dL, MCV 62 fL, a normal red cell distribution width and a normal serum ferritin. Oral iron for six weeks produced no rise in h…
- Normal pregnancy and antenatal care: teratogens · Multi-stepA child born to a woman who took warfarin in the first trimester has a flattened nasal bridge and stippled epiphyses on radiograph. Which condition is this?
- Normal pregnancy and antenatal care: drugs in pregnancy · Multi-stepA woman at 24 weeks on enalapril for chronic kidney disease has a scan showing oligohydramnios with small echogenic kidneys in the fetus. Which mechanism explains this?
- Normal pregnancy and antenatal care: immunisation · ApplicationAt her booking visit at 9 weeks, a woman is found to be non-immune to rubella. What is the correct advice?
- Normal pregnancy and antenatal care: Piskacek sign · ApplicationOn bimanual examination at 8 weeks, one cornu of the uterus bulges more than the other and the uterus feels asymmetrical. Which sign is this, and what explains it?
- Normal pregnancy and antenatal care: Hofbauer cells · ApplicationA term placenta is examined microscopically. The core of the chorionic villi contains large, round, vacuolated cells that act as macrophages and are of fetal origin. Wh…
- Normal pregnancy and antenatal care: amniotic fluid optical density · ApplicationIn a woman with Rh alloimmunisation, the amniotic fluid shows a rise in optical density deviation at 450 nm. Which substance does this reading reflect?
- Normal pregnancy and antenatal care: anti-D after sensitisation · Multi-stepA Rh-negative primigravida at 20 weeks has a positive indirect Coombs test with anti-D antibodies at a titre of 1:64. She asks if anti-D immunoglobulin will protect the…
- Normal pregnancy and antenatal care: amniotic fluid AFP and acetylcholinesterase · Multi-stepAt 17 weeks, maternal serum AFP is 3.2 MoM. Amniocentesis shows raised amniotic fluid AFP, and gel electrophoresis shows an acetylcholinesterase band. What does this co…
- Normal pregnancy and antenatal care: nausea and vomiting of pregnancy · ApplicationA woman at 8 weeks has persistent nausea and vomiting with no dehydration or ketonuria. Dietary advice has failed. Which medication is a first-line drug?
- Normal pregnancy and antenatal care: blood pressure in pregnancy · ApplicationA healthy normotensive woman has blood pressure readings of 100/60 mmHg at 20 weeks, lower than her pre-pregnancy values, although cardiac output has risen. What mainly…
- Normal pregnancy and antenatal care: thyroid binding in pregnancy · ApplicationA healthy pregnant woman at 16 weeks has a total T4 above the usual adult range, with normal TSH and normal free T4. What explains this?
- Normal pregnancy and antenatal care: alkaline phosphatase · ApplicationAt 30 weeks a healthy woman has serum alkaline phosphatase twice the upper limit of normal, with normal bilirubin, transaminases and bile acids. What is the explanation?
- Normal pregnancy and antenatal care: trisomy 18 serum screening · ApplicationA 36-year-old woman at 16 weeks has a second-trimester screen showing low alpha-fetoprotein, low unconjugated oestriol, low total hCG and low inhibin A. Which fetal con…
- Normal pregnancy and antenatal care: coagulation changes · ApplicationPregnancy is a hypercoagulable state. Which of the following coagulation parameters is characteristically decreased in a normal pregnancy?
- Normal pregnancy and antenatal care: acid-base in pregnancy · ApplicationA healthy woman at 30 weeks, breathing room air, has arterial blood gas values of pH 7.44, PaCO2 30 mmHg, and bicarbonate 20 mEq/L. How should this result be interpreted?
- Normal pregnancy and antenatal care: fetal haemoglobin · ApplicationFetal blood takes up oxygen from maternal blood across the placenta even though the fetal PaO2 is only about 30 mmHg. Which property of fetal haemoglobin (HbF) mainly e…
- Normal pregnancy and antenatal care: steroid sulfatase deficiency · Multi-stepA second-trimester screen shows markedly low maternal unconjugated oestriol with normal AFP and hCG. The male fetus is structurally normal, the fetal adrenals are norma…
- Normal pregnancy and antenatal care: cordocentesis · ApplicationA fetus at 24 weeks with suspected severe anaemia needs a direct blood sample for haemoglobin and for an intrauterine transfusion. Which procedure provides access to fe…
- Normal pregnancy and antenatal care: early chorionic villus sampling · ApplicationA woman at 8 weeks undergoes chorionic villus sampling for prenatal diagnosis. Why is the procedure normally postponed until 10 to 13 weeks?
- Normal pregnancy and antenatal care: cystic hygroma · ApplicationA first-trimester scan shows a large septated cystic swelling over the fetal neck with generalised skin oedema. Which chromosomal abnormality is most strongly associate…
- Normal pregnancy and antenatal care: biophysical profile marker of chronic hypoxia · ApplicationA biophysical profile combines an NST with four ultrasound observations. Which component is regarded as the marker of chronic fetal compromise rather than of acute hypo…
Medical disorders in pregnancy18
- Medical disorders in pregnancy: heart disease · ApplicationWhich cardiac condition carries the highest maternal mortality in pregnancy?
- Medical disorders in pregnancy: anticoagulation in valves · Multi-stepA woman with a mechanical mitral valve on warfarin is pregnant. Which statement is correct?
- Medical disorders in pregnancy: peripartum cardiomyopathy · ApplicationA woman presents with breathlessness 3 weeks after delivery. Echocardiography shows an ejection fraction of 30 per cent with no other cause. Which adjunct therapy has b…
- Medical disorders in pregnancy: tuberculosis · ApplicationWhich antitubercular drug should be avoided in pregnancy because of fetal ototoxicity?
- Medical disorders in pregnancy: malaria · Multi-stepUnder Indian national guidance, which regimen is recommended for uncomplicated Plasmodium falciparum malaria in the first trimester?
- Medical disorders in pregnancy: HIV and PMTCT · ApplicationAccording to Indian NACO guidelines, what is offered to a pregnant woman newly diagnosed with HIV?
- Medical disorders in pregnancy: hepatitis B · ApplicationA newborn is born to a HBsAg and HBeAg positive mother. What is the recommended management?
- Medical disorders in pregnancy: syphilis · ApplicationWhich is the drug of choice for syphilis in pregnancy?
- Medical disorders in pregnancy: haemoglobinopathy · ApplicationBoth partners are carriers of beta thalassaemia trait. At what stage and by what method can prenatal diagnosis be done earliest?
- Medical disorders in pregnancy: viral hepatitis E · ApplicationA woman at 32 weeks in a flood-affected area presents with jaundice and encephalopathy. Which infection carries a particularly high maternal mortality (up to 20 to 25 p…
- Medical disorders in pregnancy: acute fatty liver · Multi-stepA woman at 36 weeks presents with nausea, jaundice, hypoglycaemia, raised ammonia and prolonged prothrombin time with only mildly raised transaminases. What is the diag…
- Medical disorders in pregnancy: venous thromboembolism · ApplicationA pregnant woman at 22 weeks is diagnosed with acute deep vein thrombosis of the left leg. Which anticoagulant is preferred?
- Medical disorders in pregnancy: pregnancy-related UTI · ApplicationA woman at 30 weeks develops fever with chills, flank pain and costovertebral angle tenderness. What is the management?
- Medical disorders in pregnancy: gestational diabetes treatment · ApplicationA woman with gestational diabetes has fasting plasma glucose above target despite 2 weeks of diet therapy. What is the preferred next step?
- Medical disorders in pregnancy: epilepsy · ApplicationWhich antiepileptic drug is associated with a haemorrhagic disease of the newborn through vitamin K deficiency?
- Medical disorders in pregnancy: sickle cell crisis · Multi-stepA 26-year-old woman with sickle cell disease at 30 weeks presents with severe bone pain, tachycardia and oxygen saturation of 91 percent. Which initial management is mo…
- Medical disorders in pregnancy: hepatitis C · ApplicationA woman at 20 weeks is found to be anti-HCV positive with detectable HCV RNA. Which statement about her care is correct?
- Medical disorders in pregnancy: acute pancreatitis · ApplicationA woman at 34 weeks presents with severe epigastric pain radiating to the back, vomiting and a markedly raised serum amylase. What is the most common cause in pregnancy?
Infertility and contraception15
- Infertility and contraception: fertility preservation · Multi-stepA 28-year-old unmarried woman with breast cancer is to start chemotherapy in 10 days and wants her own biological children later. Which option is best?
- Infertility and contraception: Standard Days Method · ApplicationA woman with regular cycles of 26 to 32 days chooses a fertility-awareness method using a string of coloured beads. On which cycle days should she avoid unprotected int…
- Infertility and contraception: AZFc deletion · Multi-stepAn azoospermic man has a complete deletion of the AZFc region of the Y chromosome. Which statement is correct?
- Infertility and contraception: OHSS prevention · Multi-stepA woman with PCOS on a GnRH antagonist IVF cycle has 28 follicles on the day of trigger. Which change lowers her risk of ovarian hyperstimulation syndrome?
- Infertility and contraception: clomiphene anti-oestrogenic effects · ApplicationA woman ovulates on clomiphene but remains infertile. Midcycle cervical mucus is scanty and the endometrium is thin. Which property of the drug explains this?
- Infertility and contraception: laparoscopic ovarian drilling · ApplicationA woman with PCOS fails to conceive on clomiphene and letrozole, and wants to avoid the multiple-pregnancy risk of injectable gonadotropins. Which procedure can restore…
- Infertility and contraception: multiple pregnancy risk · ApplicationWhich method of ovulation induction carries the highest risk of multiple pregnancy, including higher-order multiples?
- Infertility and contraception: non-reducing right varicocele · Multi-stepA 35-year-old infertile man has a right-sided varicocele that does not empty when he lies down. What should be done?
- Infertility and contraception: progestogen type and venous thromboembolism · ApplicationAmong the progestogens in combined oral contraceptives, which is associated with the lowest venous thromboembolism risk?
- Infertility and contraception: nonoxynol-9 spermicide · ApplicationFrequent use of a vaginal spermicide containing nonoxynol-9 is discouraged in women at risk of HIV because it:
- Infertility and contraception: pregnancy after tubal ligation · ApplicationA woman who underwent tubal ligation 3 years ago has missed her period and has a positive urine pregnancy test. Which diagnosis must be urgently excluded?
- Infertility and contraception: DMPA and bone mineral density · ApplicationWhich contraceptive is associated with a reversible reduction in bone mineral density with long-term use?
- Infertility and contraception: spermatogenic cycle · ApplicationA man had a high fever 6 weeks ago, and his semen analysis now shows oligozoospermia. When should it be repeated to judge recovery?
- Infertility and contraception: hypogonadotropic hypogonadism in men · Multi-stepA man with azoospermia has low FSH, low LH and low testosterone, with a normal pituitary MRI, and wants fertility. What is the treatment of choice?
- Infertility and contraception: endometrioma surgery before IVF · Multi-stepA woman with infertility and a 4 cm asymptomatic ovarian endometrioma is planned for IVF. What is the concern with cystectomy before treatment?
Labor15
- Labor · ApplicationWhat is the usual first stage endpoint?
- Labor · ApplicationWhat is the third stage of labor?
- Labor · ApplicationWhat describes fetus lying transverse to maternal axis?
- Labor · ApplicationWhat does rupture of membranes before labor onset describe?
- Labor · ApplicationWhat is uterine tachysystole?
- Labor · ApplicationWhat is the usual first stage of labor?
- Labor · ApplicationWhat hormone is chiefly responsible for uterine contractions in labor?
- Labor · ApplicationWhat finding indicates rupture of membranes?
- Labor · ApplicationWhat is the purpose of a partograph?
- Labor · ApplicationWhat is cervical effacement?
- Labor · ApplicationWhat is the second stage of labor?
- Labor · ApplicationWhat is the first stage of labor?
- Labor · ApplicationWhat hormone reinforces uterine contractions during labor?
- Labor: arrest disorders · ApplicationDuring active labor, cervical dilatation remains unchanged despite adequate contractions over the required observation period. What is the diagnosis?
- Labor: uterine rupture · Multi-stepA patient attempting vaginal birth after a previous cesarean develops sudden abdominal pain, fetal bradycardia, loss of presenting-part station, and maternal shock. Wha…
Normal pregnancy15
- Normal pregnancy: placental hormones · ApplicationWhich statement about early placental hormone production is correct?
- Normal pregnancy: maternal physiology · ApplicationWhich of the following changes occurs in normal pregnancy?
- Normal pregnancy: respiratory changes · ApplicationWhich respiratory change is expected in a healthy woman at term?
- Normal pregnancy: fetal circulation · ApplicationIn fetal circulation, which vessel carries blood with the highest oxygen saturation?
- Normal pregnancy: weight gain by BMI · ApplicationA woman with a pre-pregnancy BMI of 22 kg/m2 attends her first antenatal visit. Based on the Institute of Medicine recommendations, what total weight gain is advised fo…
- Normal pregnancy: renal function · Multi-stepA 26-year-old at 24 weeks with fever and flank pain has a serum creatinine of 1.0 mg/dL. Her pre-pregnancy value was 0.7 mg/dL. How should this value be interpreted?
- Normal pregnancy: ureteric dilatation · ApplicationAn ultrasound at 28 weeks in an asymptomatic woman shows mild dilatation of the right renal pelvis and ureter, greater than on the left. What is the explanation?
- Normal pregnancy: fibrinogen in haemorrhage · Multi-stepAt a vaginal birth a multiparous woman has ongoing bleeding of 1200 mL despite uterotonics. Her fibrinogen is 180 mg/dL. Given that normal late-pregnancy fibrinogen is…
- Normal pregnancy: supine hypotension · ApplicationA 34-week primigravida becomes pale, sweaty and dizzy with a blood pressure of 80/50 mmHg when she lies flat for an ultrasound. The pressure normalises on turning her t…
- Normal pregnancy: placental variants · ApplicationAfter delivery the placenta shows torn blood vessels running through the membranes to a ragged edge, with no accessory lobe attached. Later heavy bleeding occurs with a…
- Normal pregnancy: circumvallate placenta · ApplicationA placenta examined after delivery has a thick, raised, greyish-white ring on the fetal surface with the membranes folded back on themselves. In which complication is t…
- Normal pregnancy: nuchal cord · ApplicationA 39-week fetus is found to have a single loose loop of cord around the neck at delivery, with a reassuring heart rate throughout. What is the recommended management?
- Normal pregnancy: pregnancy luteoma · ApplicationA woman at 30 weeks develops hirsutism and clitoromegaly, and ultrasound shows bilateral solid ovarian masses. Her testosterone is high. The female newborn is mildly vi…
- Normal pregnancy: double decidual sign · ApplicationOn transvaginal ultrasound at 5 weeks, a woman with pain and bleeding has an intrauterine fluid collection that is surrounded by two concentric echogenic rings. What do…
- Normal pregnancy: carpal tunnel syndrome · ApplicationA woman at 32 weeks has nocturnal tingling and numbness of the thumb, index and middle fingers, relieved by shaking the hand. What is the best initial management?
Obstetric emergencies15
- Obstetric emergencies · Multi-stepA woman at term in labour, cervix 5 cm dilated, has spontaneous rupture of membranes followed by fetal bradycardia. A pulsating loop of cord is felt in the vagina. What…
- Obstetric emergencies: placenta accreta spectrum · ApplicationWhich woman has the highest risk of placenta accreta?
- Obstetric emergencies: uterine inversion · ApplicationA woman develops sudden shock out of proportion to blood loss after cord traction in the third stage, with a mass at the introitus and absent fundus on abdominal palpat…
- Obstetric emergencies: Sheehan syndrome · ApplicationA woman who had severe PPH with shock 6 months ago has failure of lactation, amenorrhoea and loss of axillary hair. What is the first hormone deficiency to manifest?
- Obstetric emergencies: pulmonary embolism · Multi-stepA pregnant woman at 28 weeks with suspected pulmonary embolism and a normal chest radiograph needs imaging. Which is acceptable?
- Obstetric emergencies: maternal sepsis · ApplicationA postpartum woman has fever, tachycardia, hypotension and foul-smelling lochia. What is the key time target for antibiotics?
- Obstetric emergencies: maternal near miss · Multi-stepWhich of the following best defines a maternal near-miss?
- Obstetric emergencies: genital tract trauma · ApplicationA firm, contracted uterus with continuous bright red bleeding after a vaginal delivery points most likely to:
- Obstetric emergencies: maternal cardiac arrest · Multi-stepA 32-week pregnant woman collapses with cardiac arrest, and effective CPR with manual left uterine displacement has continued for 4 minutes without return of circulatio…
- Obstetric emergencies: shock index · Multi-stepA woman 30 minutes after delivery has a pulse of 118 beats per minute and a blood pressure of 100/60 mmHg with ongoing bleeding of an uncertain quantity. What is her sh…
- Obstetric emergencies: MEOWS · ApplicationA labour ward introduces a Modified Early Obstetric Warning System chart. What is its purpose?
- Obstetric emergencies: timing of rectovaginal fistula repair · Multi-stepA woman develops faecal leakage per vagina 10 days after a vaginal delivery complicated by a fourth-degree tear. Examination shows an inflamed, oedematous rectovaginal…
- Obstetric emergencies · ApplicationWhich presentation is most consistent with placental abruption?
- Obstetric emergencies · ApplicationWhich finding is typical of placenta praevia?
- Obstetric emergencies: amniotic fluid embolism · Multi-stepDuring labor, a patient suddenly develops hypoxia, hypotension, altered consciousness, and disseminated bleeding. Which rare obstetric emergency is most consistent with…
Postpartum haemorrhage12
- Postpartum haemorrhage: carbetocin · ApplicationWhich of the following uterotonics is heat-stable and does not require cold-chain storage?
- Postpartum haemorrhage: community prevention · ApplicationWhere oxytocin injection is unavailable at a home birth, what is the recommended dose of misoprostol for prevention of PPH by a trained health worker?
- Postpartum haemorrhage: tranexamic acid · ApplicationTranexamic acid should be given for the treatment of PPH:
- Postpartum haemorrhage: tamponade · ApplicationAtonic PPH continues despite oxytocin, ergometrine and carboprost. Which is the next step that is minimally invasive and preserves fertility?
- Postpartum haemorrhage: surgical · ApplicationThe B-Lynch procedure is used in the management of:
- Postpartum haemorrhage: shock garment · Multi-stepA non-pneumatic anti-shock garment is used in PPH to:
- Postpartum haemorrhage: retained placenta · ApplicationThe placenta has not been delivered 30 minutes after birth in a woman with no active bleeding. What is the next step?
- Postpartum haemorrhage: Bakri balloon test · Multi-stepIn a Bakri balloon tamponade test for PPH, the test is considered positive when:
- Postpartum haemorrhage: bimanual compression · ApplicationA woman has atonic PPH of 1000 mL with a soft, boggy uterus, and uterine massage and oxytocin are in progress. While awaiting further drugs, which first-aid manoeuvre c…
- Postpartum haemorrhage: hysterectomy technique · ApplicationA woman with refractory atonic PPH, unresponsive to drugs, balloon tamponade and compression sutures, becomes unstable and needs a life-saving hysterectomy. What is an…
- Postpartum haemorrhage: massive transfusion · Multi-stepA woman with major obstetric haemorrhage has received 4 units of red cells and remains in shock with ongoing bleeding. Which approach to blood product replacement is re…
- Postpartum haemorrhage · ApplicationWhat is an immediate management step for a boggy uterus with heavy postpartum bleeding?
Menopause11
- Menopause: hormone therapy · ApplicationA 52-year-old woman with an intact uterus has severe vasomotor symptoms. Which hormone therapy is appropriate?
- Menopause: postmenopausal bleeding · ApplicationIn a woman with postmenopausal bleeding, what is the first-line investigation?
- Menopause: tibolone · ApplicationA 55-year-old postmenopausal woman with hot flushes and low libido is prescribed tibolone. What is the characteristic of this drug?
- Menopause: genitourinary syndrome · ApplicationA 56-year-old woman, 5 years after menopause, complains only of vaginal dryness and painful intercourse. There are no hot flushes. Pelvic examination shows pale, thin v…
- Menopause · ApplicationWhat hormone pattern is typical after menopause?
- Menopause · ApplicationWhat symptom is common in menopause?
- Menopause · ApplicationWhat is a common symptom of menopause?
- Menopause · ApplicationWhat symptom is common during menopause?
- Menopause · ApplicationWhat is the most common symptom of the menopausal transition?
- Menopause · ApplicationWhat is a typical vasomotor symptom of menopause?
- Menopause: hormone therapy · ApplicationFor a patient with an intact uterus receiving systemic estrogen therapy for menopausal vasomotor symptoms, what additional hormone is generally required to protect the…
Postpartum hemorrhage10
- Postpartum hemorrhage · ApplicationWhat are retained placental tissue and uterine atony causes of?
- Postpartum hemorrhage · ApplicationWhat is the most common cause of primary postpartum hemorrhage?
- Postpartum hemorrhage · ApplicationWhat is the first-line uterotonic commonly used for uterine atony?
- Postpartum hemorrhage · ApplicationWhich cause of postpartum hemorrhage is represented by retained placental tissue?
- Postpartum hemorrhage · ApplicationWhich cause of postpartum hemorrhage is represented by genital tract laceration?
- Postpartum hemorrhage · ApplicationWhat first-line uterotonic is commonly used for uterine atony?
- Postpartum hemorrhage · ApplicationWhich mnemonic groups common causes of postpartum hemorrhage?
- Postpartum hemorrhage · Multi-stepFollowing vaginal delivery, a patient has heavy bleeding and a boggy enlarged uterus. What is the most likely cause of postpartum hemorrhage?
- Postpartum hemorrhage: retained placenta · Multi-stepAfter birth, the placenta has not delivered and heavy bleeding continues despite a firm uterus. Which cause of postpartum hemorrhage is most likely?
- Postpartum hemorrhage: uterine inversion · Multi-stepImmediately after delivery, a patient has severe pelvic pain, hemorrhage, shock disproportionate to visible loss, and a vaginal mass. What diagnosis is likely?
Gynaecological infections9
- Gynaecological infections · ApplicationA 22-year-old sexually active woman has lower abdominal pain, fever, purulent cervical discharge and cervical motion tenderness. What is the appropriate treatment?
- Gynaecological infections: PID · ApplicationWhich regimen is an appropriate outpatient treatment for mild to moderate pelvic inflammatory disease?
- Gynaecological infections: chlamydia · ApplicationChlamydia trachomatis is best described as:
- Gynaecological infections: gonorrhoea · ApplicationWhich gram-negative organism seen as intracellular diplococci in a vaginal swab causes cervicitis and is treated with ceftriaxone?
- Gynaecological infections: primary syphilis · ApplicationA woman has a single painless, indurated ulcer with a clean base on the labia and non-tender bilateral inguinal lymph nodes. Which is the likely diagnosis?
- Gynaecological infections: lymphogranuloma venereum · ApplicationA woman presents with tender, matted inguinal lymph nodes above and below the inguinal ligament forming the groove sign, with a transient painless genital papule a few…
- Gynaecological infections: genital warts · ApplicationA 24-year-old woman at 20 weeks of gestation has multiple vulval warts. Which treatment should be avoided?
- Gynaecological infections: syndromic management · ApplicationUnder the national syndromic approach, empirical treatment of a non-herpetic genital ulcer in a clinic without laboratory facilities is directed against which infections?
- Gynaecological infections: toxic shock syndrome · Multi-stepA 19-year-old develops high fever, a diffuse sunburn-like rash, vomiting, hypotension and confusion on day 4 of her period while using a super-absorbent tampon. Which i…
Puerperium9
- Puerperium · ApplicationA 28-year-old woman had severe postpartum haemorrhage with shock. Six months later she has failure of lactation, amenorrhoea, fatigue and loss of pubic hair. What is th…
- Puerperium: psychiatric disorders · ApplicationA woman 5 days after delivery has a tearful mood and anxiety, which resolves in a few days without treatment. What is the diagnosis?
- Puerperium: subinvolution · ApplicationA woman 3 weeks postpartum has persistent bleeding with a soft, bulky, tender uterus. What is the commonest cause of subinvolution?
- Puerperium: postpartum contraception · ApplicationWhich contraceptive can be offered to a fully breastfeeding woman immediately after delivery of the placenta, before discharge?
- Puerperium: septic pelvic thrombophlebitis · Multi-stepA woman 5 days after caesarean for obstructed labour has persistent spiking fever despite 72 hours of broad-spectrum intravenous antibiotics. She feels reasonably well,…
- Puerperium: postpartum thyroiditis · ApplicationA woman 3 months postpartum reports palpitations, irritability and weight loss. She has a painless small goitre, a low TSH, raised free T4 and positive anti-TPO antibod…
- Puerperium: postpartum urinary retention · ApplicationA woman 8 hours after a forceps delivery under epidural has not passed urine and complains of suprapubic discomfort. A palpable bladder is present. What is the best man…
- Puerperium: home-based postnatal care · ApplicationUnder the national home-based newborn and postpartum care schedule, for a mother who delivered in an institution, on which days does the ASHA make home visits?
- Puerperium: colonic pseudo-obstruction after caesarean · Multi-stepOn day 3 after an emergency caesarean section, a woman has massive abdominal distension and mild pain. She passes occasional flatus and bowel sounds are present. X-ray…
Antepartum haemorrhage8
- Antepartum haemorrhage · ApplicationA woman at 32 weeks has sudden painless fresh vaginal bleeding. The uterus is soft and non-tender, and the fetal heart is normal. What is the most appropriate next step?
- Antepartum haemorrhage · ApplicationA hypertensive woman at 35 weeks has sudden constant abdominal pain and dark vaginal bleeding. The uterus is hard and tender, and the fetal heart rate is abnormal. What…
- Antepartum haemorrhage · Multi-stepA multigravida with two previous caesarean sections has a placenta praevia covering the os at 32 weeks. Ultrasound shows loss of the retroplacental clear space and mult…
- Antepartum haemorrhage · Multi-stepA woman at 36 weeks has painless vaginal bleeding immediately after spontaneous rupture of membranes. The fetal heart rate becomes sinusoidal and the mother is stable.…
- Antepartum haemorrhage: vasa praevia · Multi-stepPainless vaginal bleeding occurs immediately after rupture of membranes with fetal bradycardia. Which test on the blood can confirm that it is fetal in origin?
- Antepartum haemorrhage: placenta praevia · ApplicationAn asymptomatic woman at 34 weeks has a complete placenta praevia confirmed on transvaginal ultrasound. What is the recommended timing and mode of delivery?
- Antepartum haemorrhage: abruption and DIC · Multi-stepIn concealed placental abruption, which laboratory finding best predicts severe PPH and coagulopathy?
- Antepartum haemorrhage: Couvelaire uterus · Multi-stepAt emergency caesarean for severe placental abruption the uterus appears purple and mottled with blood extravasation under the serosa, but it contracts well after oxyto…
Postpartum care8
- Postpartum care · ApplicationWhat mood symptom occurring soon after birth should be screened carefully?
- Postpartum care · ApplicationWhat term describes the normal uterine discharge that follows delivery during the postpartum period?
- Postpartum care · ApplicationWhat is a key reason to encourage early breastfeeding support?
- Postpartum care · ApplicationWhich clinical finding most strongly supports retained placental tissue after delivery?
- Postpartum care · ApplicationWhich symptom suggests postpartum endometritis?
- Postpartum care: secondary PPH · ApplicationTen days after delivery, a patient develops fever, uterine tenderness, foul-smelling lochia, and increased bleeding. Which diagnosis is most likely?
- Postpartum care: lactational mastitis · ApplicationA breastfeeding patient has focal painful breast erythema, fever, and flu-like symptoms. What is the most likely diagnosis?
- Postpartum care: psychosis · Multi-stepFive days after delivery, a patient has severe insomnia, rapidly fluctuating mood, hallucinations, and bizarre beliefs about the baby. What is the correct management pr…
Antepartum hemorrhage7
- Antepartum hemorrhage · ApplicationWhat is a typical feature of placenta previa?
- Antepartum hemorrhage · ApplicationWhat presentation is more typical of placental abruption?
- Antepartum hemorrhage · ApplicationWhat should be avoided before excluding placenta previa in significant late-pregnancy bleeding?
- Antepartum hemorrhage · ApplicationWhat bleeding pattern is typical of placental abruption?
- Antepartum hemorrhage · ApplicationWhat presentation is more typical of placenta previa?
- Antepartum hemorrhage: placenta previa · ApplicationAt 32 weeks, a patient has painless bright-red vaginal bleeding and a soft nontender uterus. Which diagnosis is most likely?
- Antepartum hemorrhage: placental abruption · Multi-stepA patient with hypertension at 35 weeks has sudden abdominal pain, a tender hypertonic uterus, vaginal bleeding, and fetal distress. What is the most likely diagnosis?
Gynecologic oncology7
- Gynecologic oncology · ApplicationPersistent postcoital bleeding requires assessment for what important cause?
- Gynecologic oncology · ApplicationWhat infection is strongly associated with cervical cancer risk?
- Gynecologic oncology · ApplicationWhich symptom pattern should prompt assessment for possible ovarian cancer?
- Gynecologic oncology: ovarian cancer · ApplicationA postmenopausal patient has persistent bloating, early satiety, pelvic pain, and increasing abdominal girth. What is the appropriate clinical concern?
- Gynecologic oncology: vulvar cancer · ApplicationAn older patient has persistent vulvar pruritus and a nonhealing vulvar lesion. What is the appropriate next step?
- Gynecologic oncology: endometrial cancer · ApplicationWhich factor increases risk of endometrial hyperplasia and carcinoma?
- Gynecologic oncology: cervical cancer · ApplicationWhich symptom should prompt assessment for possible cervical cancer even in a patient with previous screening?
Intrapartum care6
- Intrapartum care: cord prolapse · Multi-stepImmediately after rupture of membranes, fetal bradycardia is noted and a loop of umbilical cord is felt below the presenting part. What is the immediate maneuver?
- Intrapartum care: shoulder dystocia · Multi-stepAfter delivery of the fetal head, it retracts against the perineum and the shoulders fail to deliver with gentle traction. What is the first-line obstetric maneuver?
- Intrapartum care: breech presentation · ApplicationAt term, a fetus is in breech presentation. Which maneuver may be offered before labor in selected patients to attempt cephalic version?
- Intrapartum care: fetal malpresentation · ApplicationWhich fetal presentation is generally incompatible with vaginal delivery if persistent?
- Intrapartum care: amniotomy · ApplicationWhich complication should be considered before performing amniotomy when the presenting part is high and unengaged?
- Intrapartum care: meconium · ApplicationWhat is the principal neonatal concern when thick meconium is present in amniotic fluid?
Drugs in pregnancy5
- Drugs in pregnancy: teratogens · ApplicationA woman with a mechanical heart valve took warfarin throughout the first trimester. Which fetal abnormality is characteristic?
- Drugs in pregnancy: ACE inhibitors · ApplicationA pregnant woman on enalapril presents at 28 weeks with oligohydramnios. What is the likely mechanism?
- Drugs in pregnancy: lithium · ApplicationA woman with bipolar disorder on lithium becomes pregnant. First-trimester exposure is associated with which defect?
- Drugs in pregnancy: fetal alcohol syndrome · ApplicationA newborn has microcephaly, a smooth philtrum, thin upper lip, short palpebral fissures and growth restriction. The mother admits heavy alcohol use in pregnancy. Which…
- Drugs in pregnancy: isotretinoin · ApplicationA 22-year-old woman with severe nodulocystic acne is being started on oral isotretinoin. What counselling is essential?
Gestational trophoblastic disease5
- Gestational trophoblastic disease · ApplicationWhat is the usual karyotype of a complete hydatidiform mole?
- Gestational trophoblastic disease: partial mole · ApplicationWhich feature favours a partial hydatidiform mole over a complete mole?
- Gestational trophoblastic disease: follow-up · ApplicationAfter evacuation of a complete hydatidiform mole, what is the standard follow-up?
- Gestational trophoblastic disease: GTN treatment · Multi-stepA woman with post-molar gestational trophoblastic neoplasia has a FIGO prognostic score of 4. What is the treatment?
- Gestational trophoblastic disease: choriocarcinoma · ApplicationChoriocarcinoma most commonly metastasises first to which organ?
Gynaecology5
- Gynaecology · ApplicationWhat feature is most characteristic of endometriosis?
- Gynaecology · ApplicationWhich symptom warrants urgent investigation for endometrial cancer?
- Gynaecology · ApplicationWhat is the main purpose of cervical screening?
- Gynaecology · ApplicationWhich infection is a common cause of pelvic inflammatory disease?
- Gynaecology · ApplicationWhat complication can follow untreated pelvic inflammatory disease?
Multiple pregnancy5
- Multiple pregnancy: chorionicity · ApplicationOn ultrasound at 12 weeks, a twin pregnancy shows a thin membrane meeting the placenta in a T shape without a triangular projection. What does this indicate?
- Multiple pregnancy: monoamniotic twins · Multi-stepWhat is the most serious complication of monoamniotic twin pregnancy and the usual management approach?
- Multiple pregnancy: mirror syndrome · ApplicationA woman at 26 weeks with a hydropic fetus caused by a large sacrococcygeal teratoma develops generalised oedema, hypertension and haemodilution. Which term describes th…
- Multiple pregnancy: twin-twin transfusion syndrome · Multi-stepA monochorionic diamniotic twin pregnancy at 20 weeks shows a donor twin with oligohydramnios and no visible bladder, and a recipient twin with polyhydramnios and a lar…
- Multiple pregnancy: second twin transverse lie · Multi-stepA woman with a twin pregnancy has delivered the first twin vaginally. On examination the second twin lies transverse, the membranes are intact, the fetal heart is norma…
Antenatal medicine4
- Antenatal medicine: intrahepatic cholestasis · ApplicationA pregnant patient develops intense nocturnal pruritus of the palms and soles in the third trimester without a primary rash. Which test is most relevant?
- Antenatal medicine: Rh alloimmunization · Multi-stepAn RhD-negative pregnant patient has anti-D antibodies detected at a clinically significant level. What is the main fetal risk?
- Antenatal medicine: diabetes screening · ApplicationWhy is gestational diabetes screening typically performed in mid-pregnancy rather than the first trimester for average-risk patients?
- Antenatal medicine: anticoagulation · ApplicationWhy is low-molecular-weight heparin commonly preferred over warfarin for anticoagulation during pregnancy?
Antenatal screening4
- Antenatal screening · ApplicationWhat blood group issue is important to identify in pregnancy?
- Antenatal screening · ApplicationWhy is anemia screening important in pregnancy?
- Antenatal screening · ApplicationWhy is Rh status checked during pregnancy?
- Antenatal screening: neural tube defects · ApplicationWhich maternal serum screening marker is typically elevated in an open neural tube defect?
Breast health4
- Breast health · ApplicationWhat breast finding warrants prompt clinical assessment?
- Breast health · ApplicationWhat infection can occur during breastfeeding with painful breast redness and fever?
- Breast health · ApplicationWhat symptom may suggest a breast abscess during lactation?
- Breast health · ApplicationWhat breast change requires timely clinical evaluation?
Breastfeeding4
Endometriosis4
- Endometriosis · Multi-stepA 30-year-old nulliparous woman has primary infertility, progressive severe dysmenorrhoea and deep dyspareunia. Examination shows a fixed retroverted uterus and tender…
- Endometriosis: progestin therapy · Multi-stepA 27-year-old with confirmed endometriosis and dysmenorrhoea does not want contraceptives containing oestrogen because of migraine with aura. Which medical treatment is…
- Endometriosis: ultrasound of endometrioma · ApplicationA 30-year-old with dysmenorrhoea and infertility has a 5 cm unilocular ovarian cyst with homogeneous low-level internal echoes (ground-glass appearance) and no solid pa…
- Endometriosis · ApplicationWhich symptom pattern is most suggestive of endometriosis?
Oncology4
- Oncology: ovarian cancer · ApplicationPersistent bloating, early satiety, and pelvic mass warrant evaluation for what?
- Oncology: endometrium · ApplicationPostmenopausal bleeding requires exclusion of what?
- Oncology · ApplicationPostcoital bleeding requires assessment of what?
- Oncology · ApplicationWhat ovarian-cancer symptom can be persistent?
Preterm labour4
- Preterm labour · Multi-stepA woman at 29 weeks has regular contractions and the cervix is 3 cm dilated with intact membranes. Which intervention most improves the baby's outcome?
- Preterm labour: fetal fibronectin · ApplicationA woman at 30 weeks with irregular tightenings has a closed cervix of 3 cm length and a negative fetal fibronectin test. How should the result be used?
- Preterm labour: short cervix · Multi-stepA woman with a singleton pregnancy and no previous preterm birth has a transvaginal cervical length of 14 mm at the routine 20-week anomaly scan. What is the best manag…
- Preterm labour: confirming rupture of membranes · Multi-stepA woman at 33 weeks reports a gush of fluid. Sterile speculum shows pooling and a nitrazine paper that turns deep blue. In which situation would a deep blue nitrazine r…
Caesarean3
- Caesarean: Joel-Cohen technique · ApplicationA surgeon performing a Misgav-Ladach caesarean uses a Joel-Cohen skin incision. Which description is correct?
- Caesarean: antibiotic prophylaxis · ApplicationA woman is scheduled for an elective caesarean section. When should intravenous cefazolin 2 g be given to reduce surgical site infection?
- Caesarean: bladder injury · Multi-stepDuring a repeat caesarean section, clear fluid and gas appear in the urinary catheter bag, with haematuria, and a defect is noticed at the dome of the bladder. What is…
Cervical screening3
Congenital infections3
- Congenital infections: toxoplasmosis · ApplicationA woman at 20 weeks has seroconversion for Toxoplasma gondii. Which drug is started immediately to reduce transmission to the fetus?
- Congenital infections: rubella · ApplicationRubella infection acquired in the first trimester is associated with which triad?
- Congenital infections: varicella · ApplicationA non-immune pregnant woman at 24 weeks is exposed to chickenpox 4 days ago. What is the appropriate action?
Ectopic pregnancy3
- Ectopic pregnancy · ApplicationWhat is a key concern in a woman with early pregnancy pain and positive pregnancy test?
- Ectopic pregnancy · ApplicationWhat symptom should prompt urgent assessment for possible ruptured ectopic pregnancy?
- Ectopic pregnancy · ApplicationWhat symptom can suggest ruptured ectopic pregnancy?
Fetal monitoring3
Fetal surveillance3
- Fetal surveillance · ApplicationWhat does a pathological fetal heart-rate trace require?
- Fetal surveillance: cardiotocography · Multi-stepOn a cardiotocograph, recurrent decelerations begin after the peak of contractions and recover after the contraction ends. What do these late decelerations suggest?
- Fetal surveillance: variable decelerations · ApplicationA fetal heart trace shows abrupt V-shaped decelerations with variable timing in relation to contractions. What is the usual mechanism?
Gynecologic emergencies3
- Gynecologic emergencies · ApplicationWhich ovarian torsion symptom requires urgent gynecologic evaluation?
- Gynecologic emergencies: tubo-ovarian abscess · Multi-stepA patient with pelvic inflammatory disease has high fever, severe pelvic pain, leukocytosis, and a complex adnexal mass on ultrasound. What complication is most likely?
- Gynecologic emergencies: ovarian hyperstimulation · ApplicationAfter fertility treatment, a patient develops abdominal distension, ascites, hemoconcentration, enlarged ovaries, and dyspnea. What syndrome is likely?
Gynecologic infections3
Infections in pregnancy3
- Infections in pregnancy: parvovirus B19 · ApplicationA schoolteacher at 18 weeks has had contact with erythema infectiosum and now has a positive IgM for parvovirus B19. Which fetal complication should be monitored for?
- Infections in pregnancy: listeriosis · ApplicationA pregnant woman at 30 weeks has fever, myalgia and mild diarrhoea after eating soft unpasteurised cheese. Blood cultures grow Gram-positive rods with tumbling motility…
- Infections in pregnancy: group B streptococcus · Multi-stepA woman in spontaneous labour at 38 weeks has a positive rectovaginal swab for group B streptococcus at 36 weeks and no penicillin allergy. What is the appropriate intr…
Medical disorders3
- Medical disorders: anti-Ro antibodies · Multi-stepA woman with SLE who is anti-Ro positive is at 22 weeks. Fetal echocardiography shows a heart rate of 55 beats per minute with atrioventricular dissociation. What is th…
- Medical disorders: gestational thrombocytopenia · ApplicationA healthy 28-year-old at 34 weeks has an incidental platelet count of 112,000/microlitre, with a normal blood pressure, normal liver enzymes and no bleeding. Her count…
- Medical disorders: preconception care in diabetes · Multi-stepA 30-year-old woman with type 2 diabetes and an HbA1c of 9.2 percent plans pregnancy. She is on metformin and glibenclamide. Which advice is most appropriate?
Placental disorders3
- Placental disorders · ApplicationWhich bleeding pattern is most typical of placenta previa?
- Placental disorders · ApplicationWhich feature favors placental abruption over placenta previa?
- Placental disorders: accreta spectrum · Multi-stepA patient with placenta previa and multiple prior cesarean deliveries has ultrasound features of abnormal placental invasion. Which complication is most anticipated at…
Postpartum3
Sexual health3
- Sexual health: genital herpes · ApplicationA patient has recurrent painful grouped genital vesicles that ulcerate, with tender inguinal nodes. What is the most likely infection?
- Sexual health: trichomoniasis · ApplicationA patient has frothy yellow-green vaginal discharge, vulvar irritation, and punctate cervical erythema. What infection is most likely?
- Sexual health: bacterial vaginosis · ApplicationA patient has thin homogeneous gray discharge with fishy odor and clue cells on microscopy. What is the diagnosis?
Antenatal2
Diabetes in pregnancy2
Fetal presentation2
Labor emergencies2
Labour complications2
- Labour complications · ApplicationAfter delivery of the fetal head in a diabetic mother, the head retracts against the perineum (turtle sign) and the anterior shoulder fails to deliver with routine trac…
- Labour complications · ApplicationDuring third stage of labour, excessive cord traction is followed by sudden shock, severe lower abdominal pain, and a mass is seen at the vulva with the fundus not palp…
Mechanism of labor2
Obstetric drugs2
Obstetric medicine2
- Obstetric medicine: gestational diabetes · ApplicationWhat is the principal fetal consequence of poorly controlled maternal hyperglycemia in late pregnancy?
- Obstetric medicine: RhD prophylaxis · ApplicationWhat is the purpose of anti-D immunoglobulin in an unsensitized RhD-negative pregnant patient carrying a potentially RhD-positive fetus?
Operative obstetrics2
Pelvic floor2
Pelvic infection2
Placenta2
Pregnancy complications2
Preterm birth2
Abnormal uterine bleeding1
Antenatal immunohematology1
Diabetes1
Family planning1
Gestational diabetes1
Gynecologic infection1
Hypertension1
Hypertensive disorders of pregnancy1
Intrauterine fetal death1
Labour emergencies1
Labour monitoring1
Menstrual disorders1
Obstetric immunology1
Obstetric infection1
Placental development1
Polycystic ovary syndrome1
Postpartum infection1
Pregnancy dating1
Common questions
How many OBG questions are there?
918 original questions across 755 topics, and the bank grows over time.
Which OBG topics are covered?
Antenatal care, Obstetric drugs, Hypertensive disorders of pregnancy, Obstetric immunology, Gestational trophoblastic disease, Labour, Antepartum haemorrhage, Endometriosis, Puerperium, Obstetric emergencies, Gynaecological infections, Preterm labour, and more.
How difficult are these OBG questions?
0 are recall, 706 are application and 212 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these OBG questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise OBG for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed OBG test?
Yes. The OBG subject test is included with a paid term, with a countdown and a question palette.
How should I use these OBG questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these OBG questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.