A 32-year-old woman presents with secondary infertility and dysmenorrhea. Imaging shows thickened endometrial tissue outside the uterus. What is the most likely diagnosis?
Answer: B
Endometriosis is characterized by ectopic endometrial tissue outside the uterus, causing dysmenorrhea, pelvic pain, and infertility due to inflammation and mechanical obstruction.
Q.182Medium
Which of the following conditions is associated with increased risk of gestational diabetes mellitus?
Answer: C
Maternal obesity, advanced age (>35 years), family history of diabetes, and previous gestational diabetes are significant risk factors for GDM.
Q.183Medium
A pregnant woman presents with vaginal bleeding in the first trimester and a positive pregnancy test. Pelvic ultrasound shows an empty uterus. What is the most likely diagnosis?
Answer: C
An empty uterus with positive hCG indicates an ectopic pregnancy (implantation outside the uterus), which may present with vaginal bleeding, abdominal pain, and hemodynamic instability.
Q.184Medium
Which of the following is the mechanism of action of levonorgestrel as an emergency contraceptive?
Answer: B
Levonorgestrel prevents or delays ovulation when given within 72 hours of unprotected intercourse and may also alter cervical mucus to impede sperm transport.
Q.185Medium
A 24-year-old woman with irregular cycles is diagnosed with polycystic ovary syndrome. Which hormonal finding is most characteristic?
Answer: B
PCOS is characterized by elevated LH levels relative to FSH (typically LH:FSH ratio >3:1), along with hyperandrogenism and insulin resistance.
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Q.186Medium
Which statement about human milk lactation is correct?
Answer: D
Oxytocin triggers the milk ejection reflex (letdown reflex), while prolactin stimulates milk production. Both hormones are essential for successful lactation.
Q.187Medium
Which of the following pathogens is the leading cause of congenital infections in the TORCH group?
Answer: C
CMV is the most common congenital infection, affecting 0.5-1% of live births and causing microcephaly, hearing loss, and developmental delays if acquired in utero.
Q.188Medium
During spermatogenesis, which cell type directly gives rise to mature spermatozoa?
Answer: D
Spermatids undergo spermiogenesis (morphological changes) to transform into mature spermatozoa. This is the final stage of spermatogenesis.
Q.189Medium
A 40-year-old man presents with erectile dysfunction and is found to have low testosterone levels. Which of the following hormones directly stimulates testosterone production in Leydig cells?
Answer: B
LH acts on Leydig cells in the testes to stimulate testosterone synthesis and secretion. Low LH indicates secondary hypogonadism.
Q.190Medium
A 28-year-old woman has not conceived after 18 months of unprotected intercourse. Which investigation should be performed FIRST?
Answer: C
Male factor infertility accounts for 40% of cases. Semen analysis is non-invasive, cost-effective, and should be the first investigation when evaluating an infertile couple.
Q.191Medium
A 32-year-old man presents with azoospermia. Semen analysis shows normal seminal fluid parameters but absence of spermatozoa. What is the most likely diagnosis?
Answer: B
Normal seminal fluid with absent sperm indicates obstruction in the reproductive tract rather than failed production. This is obstructive azoospermia, often due to vasectomy, absence of vas deferens, or ejaculatory duct obstruction.
Q.192Medium
A 26-year-old woman with history of pelvic inflammatory disease presents with infertility. Which imaging modality is MOST appropriate to assess tubal patency?
Answer: B
HSG is the gold standard for assessing tubal patency and detecting tubal blockage or damage. It uses radiographic contrast to visualize the fallopian tubes.
Q.193Medium
A woman using combined oral contraceptive pills (COCs) presents with breakthrough bleeding. Which action should be taken?
Answer: B
Breakthrough bleeding is common in the first 3 months of COC use and usually resolves spontaneously. Continuation of the same regimen is recommended unless bleeding persists beyond 3 months.
Q.194Medium
Which contraceptive method is absolutely contraindicated in women with current or history of breast cancer?
Answer: B
Combined oral contraceptives containing estrogen are contraindicated in breast cancer patients due to estrogen's proliferative effects. Copper IUD, progestin-only methods, and barrier methods are safe alternatives.
Q.195Medium
A 34-year-old man has oligozoospermia with motility of 20%. Which of the following is the most likely etiology?
Answer: D
Varicocele is the most common correctable cause of male infertility. Fever temporarily affects spermatogenesis for 2-3 months. Smoking reduces sperm count and motility. All are valid etiologies of oligozoospermia.
Q.196Medium
What is the window period during which emergency contraception is most effective?
Answer: C
Levonorgestrel (Plan B) is effective within 120 hours (5 days) if taken within 72 hours for maximum efficacy. Ulipristal acetate (a selective progesterone receptor modulator) can be used up to 120 hours.
Q.197Medium
Which of the following best describes the mechanism of action of levonorgestrel IUD in preventing pregnancy?
Answer: B
Levonorgestrel IUD works primarily by altering the endometrium to prevent implantation and secondarily by thickening cervical mucus. Complete ovulation inhibition occurs in only 20-30% of cycles.
Q.198Medium
A 31-year-old woman presents with secondary amenorrhea and infertility. Blood tests show elevated prolactin levels. What is the next appropriate investigation?
Answer: B
Elevated prolactin requires MRI of pituitary to rule out prolactinoma, which is the most common pathological cause of hyperprolactinemia. Thyroid tests should be done to exclude hypothyroidism as a cause.
Q.199Medium
A 35-year-old woman with polycystic ovary syndrome (PCOS) seeks contraception with metabolic benefits. Which method would be most appropriate?
Answer: A
Combined OCPs with anti-androgenic progestins (like cyproterone acetate or spironolactone) provide contraception while treating PCOS-related hyperandrogenism and improving metabolic parameters.
Q.200Medium
In a food chain, what percentage of energy is typically transferred from one trophic level to the next?
Answer: B
The 10% law states that only about 10% of energy is transferred to the next trophic level; the remaining 90% is lost as heat and used in metabolism.
